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General NPI Number Information
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NPI Number | 1144332453
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Entity Type | Organization
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Legal Business Name | WESTERN RADIOLOGY IMAGING LLC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 03/25/2019
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Provider Practice Location Address
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Address Line | 11011 MERIDIAN AVE N SUITE 101
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City | SEATTLE
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State | WA
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Zip | 98133-8967
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Country | US
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Telephone | 206-306-1011
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Fax | 206-306-1019
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Provider Business Mailing Address
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Address Line | PO BOX 24722
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City | SEATTLE
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State | WA
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Zip | 98124-0722
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Country | US
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Telephone | 206-306-1011
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Fax | 206-306-1019
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Authorized Official
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Title or Position | CONTROLLER
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Name | LORI GANAL
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Credential |
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Telephone | 206-365-4100
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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 | UBI 602469354
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License Number State | WA
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