Provider Demographics
NPI:1992819866
Name:TRI CITY RADIOLOGY INC PS
Entity type:Organization
Organization Name:TRI CITY RADIOLOGY INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:K
Authorized Official - Last Name:BRESNAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHR
Authorized Official - Phone:509-374-4030
Mailing Address - Street 1:7221 W DESCHUTES AVE
Mailing Address - Street 2:STE A
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7807
Mailing Address - Country:US
Mailing Address - Phone:509-374-4030
Mailing Address - Fax:509-374-8690
Practice Address - Street 1:7221 W DESCHUTES AVE
Practice Address - Street 2:STE A
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7807
Practice Address - Country:US
Practice Address - Phone:509-374-4030
Practice Address - Fax:509-374-8690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7823107Medicaid
WA14228OtherL & I
WA7823107Medicaid