Provider Demographics
NPI:1588904338
Name:TRA-MINW, PS
Entity type:Organization
Organization Name:TRA-MINW, PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:EPSHTEYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-761-4200
Mailing Address - Street 1:PO BOX 3656
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-3656
Mailing Address - Country:US
Mailing Address - Phone:866-231-9211
Mailing Address - Fax:800-508-4751
Practice Address - Street 1:1601 SE COURT AVE
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-3217
Practice Address - Country:US
Practice Address - Phone:253-761-4200
Practice Address - Fax:253-383-0730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-14
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric RadiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500663945Medicaid
ORR169046Medicare PIN