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General NPI Number Information
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NPI Number | 1376504803
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Entity Type | Organization
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Legal Business Name | SAMARITAN INLAND MRI LLC
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Dates
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Enumeration Date | 04/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1550 S PIONEER WAY
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City | MOSES LAKE
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State | WA
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Zip | 98837-4613
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Country | US
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Telephone | 509-747-4455
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Fax | 509-363-7064
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Provider Business Mailing Address
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Address Line | 1550 S PIONEER WAY
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City | MOSES LAKE
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State | WA
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Zip | 98837-4613
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Country | US
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Telephone | 509-747-4455
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Fax | 509-363-7064
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Authorized Official
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Title or Position | CAO
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Name | KATHLEEN WILSON
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Credential |
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Telephone | 509-747-4455
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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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