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General NPI Number Information
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NPI Number | 1124046057
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Entity Type | Organization
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Legal Business Name | RADIOLOGY CONSULTANTS OF WASHINGTON, INC., P.S.
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 09/23/2021
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Provider Practice Location Address
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Address Line | 12112 115TH AVE NE STE B
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City | KIRKLAND
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State | WA
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Zip | 98034-6958
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Country | US
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Telephone | 425-821-3472
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Fax | 425-820-4115
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Provider Business Mailing Address
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Address Line | PO BOX 94624
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City | SEATTLE
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State | WA
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Zip | 98124-6924
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Country | US
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Telephone | 425-821-3472
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Fax | 425-820-4115
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHANE E. MACAULAY
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Credential | M.D.
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Telephone | 425-821-3472
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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