Organization
MERCER ISLAND MEDICAL IMAGING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINE E. DWIGHT (CHIEF OPERATIONS OFFICER)
(253) 761-4200
Entity
Organization
Contact information
Practice address
9655 SE 36TH ST, SUITE 107, MERCER ISLAND, WA 98040-3798
(253) 761-4200
(253) 383-3553
Mailing address
PO BOX 2135, TACOMA, WA 98401-2135
(253) 761-4200
(253) 383-3553
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0028ME
REGENCE
WA
05
—
7148976
—
WA
01
—
G8886633
PTAN
WA
01
—
O255941
LABOR & INDUSTRIES, CRIME VICTIMS COMPENSATION
WA
Enumeration date
10/02/2009
Last updated
01/19/2011
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