MEDICARE: OBJECTIVE DIAGNOSTICS & RESEARCH PS

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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center		WA

General Provider Information

NPI Number	:	1467666701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OBJECTIVE DIAGNOSTICS & RESEARCH PS

Provider Business Mailing Address
First Line	:	4803 CENTER ST
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98409-2319
Country	:	US
Telephone Number	:	253-460-7234
Fax Number	:

Provider Business Practice Location Address
First Line	:	4803 CENTER ST
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98409-2319
Country	:	US
Telephone Number	:	253-460-7234
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK ALLEN WOODHAM
Credential	:	D.C.
Telephone Number	:	253-460-7234

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	08/22/2020

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