Provider Demographics
NPI:1588788731
Name:MEDICAL IMAGING NORTHWEST, LLP
Entity type:Organization
Organization Name:MEDICAL IMAGING NORTHWEST, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN EXECUTIVE COMMITTEE
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-841-4353
Mailing Address - Street 1:7424 BRIDGEPORT WAY W
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-8120
Mailing Address - Country:US
Mailing Address - Phone:253-841-4353
Mailing Address - Fax:253-581-5698
Practice Address - Street 1:11212 SUNRISE BLVD E
Practice Address - Street 2:SUITE 200
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-8847
Practice Address - Country:US
Practice Address - Phone:253-841-4353
Practice Address - Fax:253-581-5698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7817505Medicaid