Organization
SOUTHWEST WASHINGTON DIAGNOSTICS LP
Active
Organization
SOUTHWEST WASHINGTON DIAGNOSTICS LP
Active
Other names
Washington Diagnostics
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LAURA A THEIS (CLINIC SUPERVISOR)
(360) 736-0200
Entity
Organization
Contact information
Practice address
910 S SCHEUBER RD, CENTRALIA, WA 98531-9027
(360) 736-0200
(360) 736-0380
Mailing address
910 S SCHEUBER RD, CENTRALIA, WA 98531-9027
(360) 736-0200
(360) 736-0380
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
41265
L & I
WA
05
—
7050479
—
WA
Enumeration date
09/23/2005
Last updated
02/27/2012
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