Organization
LONGVIEW RADIOLOGISTS, P.S. INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GINA VICARS (MANAGER)
(360) 425-5131
Entity
Organization
Contact information
Practice address
700 LINCOLN ST, SUITE 100, KELSO, WA 98626-1057
(360) 425-5131
(360) 425-5509
Mailing address
700 LINCOLN ST, SUITE 100, KELSO, WA 98626-1057
(360) 425-5131
(360) 425-5509
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111948
OREGON DSHS
OR
01
—
12841
LABOR & INDUSTRIES
WA
01
—
60010
REGENCE BLUE SHIELD
WA
05
—
7839301
—
WA
01
—
CP7616
RAILROAD MEDICARE
WA
Enumeration date
05/20/2006
Last updated
01/06/2010
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