Provider Demographics
NPI:1215918081
Name:IMAGING PARTNERS AT VALLEY LLC
Entity type:Organization
Organization Name:IMAGING PARTNERS AT VALLEY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:425-656-3429
Mailing Address - Street 1:PO BOX 24235
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98093-1235
Mailing Address - Country:US
Mailing Address - Phone:253-661-1700
Mailing Address - Fax:253-661-4565
Practice Address - Street 1:400 S 43RD ST
Practice Address - Street 2:OLYMPIC BUILDING
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5714
Practice Address - Country:US
Practice Address - Phone:425-656-5550
Practice Address - Fax:425-656-5552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7116700Medicaid
WA7116700Medicaid