Basic Information
| Provider Information | |||||||||
| NPI: | 1013907955 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHWEST RADIOLOGISTS INC PS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2930 SQUALICUM PKWY | ||||||||
| Address2: | SUITE B10 | ||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982251854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607330430 | ||||||||
| FaxNumber: | 3607330438 | ||||||||
| Practice Location | |||||||||
| Address1: | 2901 SQUALICUM PKWY | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982251851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607345400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2005 | ||||||||
| LastUpdateDate: | 02/05/2021 | ||||||||
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| AuthorizedOfficialLastName: | BUDZIER | ||||||||
| AuthorizedOfficialFirstName: | ALAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3607330430 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 600013922 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 7824808 | 05 | WA | MEDICAID |