Provider Demographics
NPI:1427278126
Name:KITTITAS VALLEY OPEN MRI CORP
Entity type:Organization
Organization Name:KITTITAS VALLEY OPEN MRI CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MRI TECHNOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:IZZI
Authorized Official - Suffix:
Authorized Official - Credentials:RT(R)
Authorized Official - Phone:509-899-4175
Mailing Address - Street 1:301 PROSPECT ST STE 5
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 E JACKSON AVE
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3633
Practice Address - Country:US
Practice Address - Phone:509-899-4175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty