Provider Demographics
NPI:1144332453
Name:WESTERN RADIOLOGY IMAGING LLC
Entity type:Organization
Organization Name:WESTERN RADIOLOGY IMAGING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:GANAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-365-4100
Mailing Address - Street 1:PO BOX 24722
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0722
Mailing Address - Country:US
Mailing Address - Phone:206-306-1011
Mailing Address - Fax:206-306-1019
Practice Address - Street 1:11011 MERIDIAN AVE N
Practice Address - Street 2:SUITE 101
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8967
Practice Address - Country:US
Practice Address - Phone:206-306-1011
Practice Address - Fax:206-306-1019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAUBI 6024693542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA613160100OtherOWCP
WA206464OtherGROUP L&I
WA7135825Medicaid
WADF0569OtherRR MEDI
WA7028WEOtherREGENCE GROUP#
WA602469354OtherUBI#
WA602469354OtherUBI#