Basic Information
| Provider Information | |||||||||
| NPI: | 1124046057 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RADIOLOGY CONSULTANTS OF WASHINGTON, INC., P.S. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | RAYUS RADIOLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 94624 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981246924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258213472 | ||||||||
| FaxNumber: | 4258204115 | ||||||||
| Practice Location | |||||||||
| Address1: | 12112 115TH AVE NE STE B | ||||||||
| Address2: | |||||||||
| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980346958 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258213472 | ||||||||
| FaxNumber: | 4258204115 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 09/23/2021 | ||||||||
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| AuthorizedOfficialLastName: | MACAULAY | ||||||||
| AuthorizedOfficialFirstName: | SHANE | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4258213472 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 09/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 7044795 | 05 | WA | MEDICAID |