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General NPI Number Information
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NPI Number | 1811005861
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Entity Type | Organization
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Legal Business Name | BDC RADIOLOGY INC PS
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 07/17/2014
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Provider Practice Location Address
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Address Line | 1268 E MAIN ST SUITE 1
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City | AUBURN
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State | WA
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Zip | 98002-5748
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Country | US
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Telephone | 253-735-1991
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Fax | 253-735-8837
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Provider Business Mailing Address
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Address Line | 1268 E MAIN ST SUITE 1
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City | AUBURN
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State | WA
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Zip | 98002-5748
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Country | US
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Telephone | 253-735-1991
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Fax | 253-735-8837
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN T BLACKWELDER
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Credential | MD
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Telephone | 253-735-1991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 602300908
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License Number State | WA
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