Organization
RUSS REYNOLDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSS K REYNOLDS RT (OWNER)
(509) 884-0602
Entity
Organization
Contact information
Practice address
220 25TH ST NE, EAST WENATCHEE, WA 98802-4097
(509) 884-0602
(509) 884-0602
Mailing address
220 25TH ST NE, EAST WENATCHEE, WA 98802-4097
(509) 884-0602
(509) 884-0602
Taxonomy
Speciality
Code
Description
License number
State
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
RT00003044
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7015290
—
WA
Enumeration date
03/05/2008
Last updated
11/26/2013
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