Organization
SOUTH SOUND RADIOLOGY - LEWIS COUNTY
Active
Parent organization
SOUTH SOUND RADIOLOGIST INC P S
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTH SOUND RADIOLOGIST INC P S
Authorized official
MRS. STEPHANIE R DIRCKX M.D. (EXECUTIVE DIRECTOR)
(360) 493-4612
Entity
Organization
Contact information
Practice address
914 S SCHEUBER RD, CENTRALIA, WA 98531-9027
(360) 330-8508
(360) 330-8583
Mailing address
3417 ENSIGN RD NE, OLYMPIA, WA 98506-5064
(360) 493-4600
(360) 493-4603
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
311408
LABOR & INDUSTRIES
WA
01
—
G8918611
MEDICARE GROUP PTAN
WA
Enumeration date
12/21/2012
Last updated
04/18/2014
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