Provider Demographics
NPI:1588775662
Name:LYNDEN MEDICAL X-RAY LLC
Entity type:Organization
Organization Name:LYNDEN MEDICAL X-RAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER TECHNOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:B
Authorized Official - Last Name:VAN BEEK
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:360-360-1237
Mailing Address - Street 1:9310 HAMMER RD
Mailing Address - Street 2:
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-9530
Mailing Address - Country:US
Mailing Address - Phone:360-354-5419
Mailing Address - Fax:360-354-5400
Practice Address - Street 1:9310 HAMMER RD
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-9530
Practice Address - Country:US
Practice Address - Phone:360-354-5419
Practice Address - Fax:360-354-5400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WART00002493261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB07353Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER