Basic Information
| Provider Information | |||||||||
| NPI: | 1427432475 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HIGHLINE MEDICAL CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HIGHLINE IMAGING | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 94586 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981246886 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8777467096 | ||||||||
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| Practice Location | |||||||||
| Address1: | 275 SW 160TH ST | ||||||||
| Address2: | |||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981663003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069885774 | ||||||||
| FaxNumber: | 2062442569 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2015 | ||||||||
| LastUpdateDate: | 07/18/2015 | ||||||||
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| AuthorizedOfficialLastName: | BENEDUM | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 2069885774 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.