Provider Demographics
NPI:1295725133
Name:MT BAKER IMAGING LLC
Entity type:Organization
Organization Name:MT BAKER IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-788-9004
Mailing Address - Street 1:PO BOX 24326
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0326
Mailing Address - Country:US
Mailing Address - Phone:360-647-2422
Mailing Address - Fax:360-255-2263
Practice Address - Street 1:2930 SQUALICUM PKWY STE 101
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1854
Practice Address - Country:US
Practice Address - Phone:360-733-0430
Practice Address - Fax:360-594-4012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-23
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6024903562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7128143Medicaid
WA7128143Medicaid