Provider Demographics
NPI:1063606309
Name:BELLEVUE MEDICAL IMAGING, PLLC
Entity type:Organization
Organization Name:BELLEVUE MEDICAL IMAGING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:JOHANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-454-1700
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98009-0727
Mailing Address - Country:US
Mailing Address - Phone:425-454-1700
Mailing Address - Fax:425-454-0600
Practice Address - Street 1:1400 116TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3816
Practice Address - Country:US
Practice Address - Phone:425-454-1700
Practice Address - Fax:425-454-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA22661247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty