Organization Active NPI

Medical Imaging Northwest, LLP

  • Diagnostic Radiology Physician
  • Puyallup, WA
National Provider Identifier
1588788731
Registry record updated Nov 7, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
MEDICAL IMAGING NORTHWEST, LLP
Practice address
11212 Sunrise Blvd E
Suite 200
Puyallup, WA 98374-8847
Phone
(253) 841-4353
Fax
(253) 581-5698
NPI assigned
Mar 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2007

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

Authorized official

Name
Dr. Andrew R Levine, MD
Title
Chairman Executive Committee
Phone
(253) 841-4353

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

11212 Sunrise Blvd E
Suite 200
Puyallup, WA 98374-8847

Mailing address

7424 Bridgeport Way W
Suite 103
Lakewood, WA 98499-8120
Phone (253) 841-4353

Other identifiers 1

IdentifierTypeStateIssuer
7817505MedicaidWA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194393600000",
    "number": "1588788731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7424 BRIDGEPORT WAY W",
            "address_2": "SUITE 103",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984998120",
            "telephone_number": "253-841-4353",
            "fax_number": "253-581-5698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11212 SUNRISE BLVD E",
            "address_2": "SUITE 200",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983748847",
            "telephone_number": "253-841-4353",
            "fax_number": "253-581-5698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL IMAGING NORTHWEST, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-16",
        "last_updated": "2007-11-07",
        "status": "A",
        "authorized_official_last_name": "LEVINE",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CHAIRMAN EXECUTIVE COMMITTEE",
        "authorized_official_telephone_number": "253-841-4353",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7817505",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Puyallup, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2007; 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.