Healthcare Provider Details

I. General information

NPI: 1689283285
Provider Name (Legal Business Name): DIRECT IMAGING PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 SUMMITVIEW AVE STE 200
YAKIMA WA
98908-3028
US

IV. Provider business mailing address

6101 SUMMITVIEW AVE STE 200
YAKIMA WA
98908-3028
US

V. Phone/Fax

Practice location:
  • Phone: 509-902-8857
  • Fax: 509-902-8855
Mailing address:
  • Phone: 509-902-8857
  • Fax: 509-902-8855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DAVE S ATTEBERRY
Title or Position: OWNER/MEMBER
Credential: MD
Phone: 412-759-8895