Img Wa LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

IMG WA LLC

Practice address

300 Deschutes Way SW Ste 304
Tumwater, WA 98501-7719

Phone

(800) 564-1303

NPI assigned

Jul 28, 2017

Organization subpart

No

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

Authorized official

Name

Tim McMenamin

Title

Manager

Phone

(800) 564-1303

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1501200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1780108027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 DESCHUTES WAY SW STE 304",
            "city": "TUMWATER",
            "state": "WA",
            "postal_code": "985017719",
            "telephone_number": "800-564-1303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 DESCHUTES WAY SW STE 304",
            "city": "TUMWATER",
            "state": "WA",
            "postal_code": "985017719",
            "telephone_number": "800-564-1303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMG WA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-28",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MCMENAMIN",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "800-564-1303"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.