NPIMap

Organization Active NPI

Pacific Northwest Radiology LLC

  • Diagnostic Radiology Physician
  • Cordova, AK
National Provider Identifier
1306011473
Registry record updated Apr 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
PACIFIC NORTHWEST RADIOLOGY LLC
Practice address
602 Chase Avenue
Cordova, AK 99574-0160
Phone
(907) 424-8000
NPI assigned
Apr 29, 2008
Last updated
Apr 29, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Burt Loessberg
Title
Ceo
Phone
(541) 687-7134

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X Primary

Addresses

Primary practice location

602 Chase Avenue
Cordova, AK 99574-0160

Mailing address

PO Box 26570
Fresno, CA 93729-6570
Phone (541) 687-7134

Other identifiers 2

IdentifierTypeStateIssuer
7140551MedicaidWA
MDG34ORMedicaidOR

National Provider Directory

National Provider Directory
Tax ID family
Pacific Northwest Radiology LLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1209427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209427200000",
    "number": "1306011473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26570",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937296570",
            "telephone_number": "541-687-7134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 CHASE AVENUE",
            "city": "CORDOVA",
            "state": "AK",
            "postal_code": "995740160",
            "telephone_number": "907-424-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC NORTHWEST RADIOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-29",
        "last_updated": "2008-04-29",
        "status": "A",
        "authorized_official_last_name": "LOESSBERG",
        "authorized_official_first_name": "BURT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "541-687-7134"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7140551",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MDG34OR",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cordova, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.