Provider Demographics
NPI:1154417814
Name:CPI PROFESSIONAL SERVICES, PC
Entity type:Organization
Organization Name:CPI PROFESSIONAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-699-8158
Mailing Address - Street 1:PO BOX 5469
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98668-5469
Mailing Address - Country:US
Mailing Address - Phone:360-699-8158
Mailing Address - Fax:360-699-3372
Practice Address - Street 1:2055 EXCHANGE ST STE 170
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3419
Practice Address - Country:US
Practice Address - Phone:360-699-8158
Practice Address - Fax:360-699-3372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR132287Medicaid
ORD81977Medicare UPIN
OR132287Medicaid