Provider Demographics
NPI:1588899173
Name:DYNAMIC MEDICAL DIAGNOSTIC IMAGING CENTERS, LLC
Entity type:Organization
Organization Name:DYNAMIC MEDICAL DIAGNOSTIC IMAGING CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:L
Authorized Official - Last Name:LUND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-661-1700
Mailing Address - Street 1:5038 TACOMA MALL BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-7103
Mailing Address - Country:US
Mailing Address - Phone:253-476-9900
Mailing Address - Fax:253-476-0148
Practice Address - Street 1:5038 TACOMA MALL BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7103
Practice Address - Country:US
Practice Address - Phone:253-476-9900
Practice Address - Fax:253-476-0148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602898875261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)