Provider Demographics
NPI:1962581132
Name:THERAPEUTIC RADIOLOGY OF YAKIMA PLLC
Entity type:Organization
Organization Name:THERAPEUTIC RADIOLOGY OF YAKIMA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-480-0971
Mailing Address - Street 1:PO BOX 0994
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-0994
Mailing Address - Country:US
Mailing Address - Phone:509-574-3500
Mailing Address - Fax:509-574-3530
Practice Address - Street 1:808 N 39TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-6388
Practice Address - Country:US
Practice Address - Phone:509-574-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2017-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7092125Medicaid
WA7092125Medicaid