Provider Demographics
NPI:1154942886
Name:RADIA IMAGING CENTER HOLDINGS LLC
Entity type:Organization
Organization Name:RADIA IMAGING CENTER HOLDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BART
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:KEOGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-563-1500
Mailing Address - Street 1:19020 33RD AVE W STE 210
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4748
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:
Practice Address - Street 1:4816 NE THURSTON WAY STE A
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6661
Practice Address - Country:US
Practice Address - Phone:360-254-4914
Practice Address - Fax:360-449-4987
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RADIA INC PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty