Healthcare Provider Details

I. General information

NPI: 1396814166
Provider Name (Legal Business Name): TRA-MINW P S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 S UNION AVE
TACOMA WA
98405-1328
US

IV. Provider business mailing address

PO BOX 3656
SEATTLE WA
98124-3656
US

V. Phone/Fax

Practice location:
  • Phone: 253-761-4200
  • Fax: 253-761-4201
Mailing address:
  • Phone: 866-231-9211
  • Fax: 253-761-4201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA EPSHTEYN
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 253-761-4200