Provider Demographics
NPI:1750704540
Name:TACOMA DIAGNOSTIC IMAGING CENTER, LLC
Entity type:Organization
Organization Name:TACOMA DIAGNOSTIC IMAGING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GIESY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:253-752-6630
Mailing Address - Street 1:6004 WESTGATE BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2503
Mailing Address - Country:US
Mailing Address - Phone:253-752-6630
Mailing Address - Fax:253-752-1173
Practice Address - Street 1:6004 WESTGATE BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2503
Practice Address - Country:US
Practice Address - Phone:253-752-6630
Practice Address - Fax:253-752-1173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes292200000XLaboratoriesDental Laboratory