MEDICARE: SAMARITAN INLAND MRI LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1376504803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMARITAN INLAND MRI LLC

Provider Business Mailing Address
First Line	:	1550 S PIONEER WAY
Second Line	:
City	:	MOSES LAKE
State	:	WA
Zip	:	98837-4613
Country	:	US
Telephone Number	:	509-747-4455
Fax Number	:	509-363-7064

Provider Business Practice Location Address
First Line	:	1550 S PIONEER WAY
Second Line	:
City	:	MOSES LAKE
State	:	WA
Zip	:	98837-4613
Country	:	US
Telephone Number	:	509-747-4455
Fax Number	:	509-363-7064

Authorized Official
Title or Position	:	CAO
Name	:	KATHLEEN WILSON
Credential	:
Telephone Number	:	509-747-4455

Provider Enumeration Date	:	04/01/2006
Last Update Date	:	08/22/2020

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