Provider Demographics
NPI:1871524827
Name:YAKIMA VALLEY RADIOLOGY INC PC
Entity type:Organization
Organization Name:YAKIMA VALLEY RADIOLOGY INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:STUCKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-895-0401
Mailing Address - Street 1:PO BOX 2925
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98907-2925
Mailing Address - Country:US
Mailing Address - Phone:509-895-0402
Mailing Address - Fax:509-248-0733
Practice Address - Street 1:315 HOLTON AVE STE 102
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902
Practice Address - Country:US
Practice Address - Phone:509-895-0402
Practice Address - Fax:509-248-0733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6000314972085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7817307Medicaid
WA7817307Medicaid