Provider Demographics
NPI:1063455897
Name:SEATTLE RADIOLOGISTS A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SEATTLE RADIOLOGISTS A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEPPERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-292-6233
Mailing Address - Street 1:1229 MADISON STREET
Mailing Address - Street 2:SUITE 900
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1391
Mailing Address - Country:US
Mailing Address - Phone:206-292-6233
Mailing Address - Fax:206-292-7764
Practice Address - Street 1:1229 MADISON STREET
Practice Address - Street 2:SUITE 900
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1391
Practice Address - Country:US
Practice Address - Phone:206-292-6233
Practice Address - Fax:206-292-7764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7802606Medicaid
WA7802606Medicaid
WADB8604Medicare PIN
WA000158600Medicare PIN