SOUTH SOUND RADIOLOGY - LEWIS COUNTY (NPI# 1255677118) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255677118 |
| Entity Type | Organization |
| Organization Name | SOUTH SOUND RADIOLOGY - LEWIS COUNTY |
| Practice Address |
914 S Scheuber Rd Centralia WA 98531-9027 |
| Mailing Address |
3417 Ensign Rd Ne Olympia WA 98506-5064 |
| Practice Telephone | 3603308508 |
| Practice Fax Number | 3603308583 |
| Mailing Telephone | 3604934600 |
| Mailing Fax Number | 3604934603 |
| Enumeration Date | 2012-12-21 |
| Last Update Date | 2014-04-18 |
| Authorized Official Name | MRS. STEPHANIE R DIRCKX (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 3604934612 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | Y |
| Parent Organization Name | SOUTH SOUND RADIOLOGIST INC P S |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | LABOR & INDUSTRIES | 311408 | 01 |
| WA | MEDICARE GROUP PTAN | G8918611 | 01 |
| Street Address |
914 S SCHEUBER RD |
| City | CENTRALIA |
| State | WA |
| Zip Code | 98531-9027 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982600805 | Leena Carriere | Anesthesiology | 914 S Scheuber Rd, Pmg Sw Wa Centralia Anesthesiology, Centralia, WA 98531-9027 | 2005-06-24 |
| 1114542065 | Gary John Clinton Mersereau Sr. | Registered Nurse | 914 S Scheuber Rd, Centralia, WA 98531-9027 | 2020-06-16 |
| 1366077745 | Andrew J Maasdam | Nurse Anesthetist, Certified Registered | 914 S Scheuber Rd, Centralia, WA 98531-9027 | 2020-03-06 |
| 1447884374 | Michelle Stover | Registered Nurse | 914 S Scheuber Rd, Centralia, WA 98531-9027 | 2020-02-29 |
| 1932748993 | Erika Anne Laurentz | Counselor | 914 S Scheuber Rd, Centralia, WA 98531-9027 | 2019-12-22 |
| 1952942567 | Ashley Marie Wheeler | Emergency Medicine | 914 S Scheuber Rd, Centralia, WA 98531-9027 | 2019-10-04 |
| 1619537057 | Rebecca Kathryn Mcneil | Counselor | 914 S Scheuber Rd, Centralia, WA 98531-9027 | 2019-06-18 |
| 1982269395 | Jennifer Green | Physician Assistant | 914 S Scheuber Rd, Centralia, WA 98531-9027 | 2019-05-01 |
| 1033698519 | Jennifer Ann Reuter | Physician Assistant | 914 S Scheuber Rd, Centralia, WA 98531 | 2018-08-07 |
| 1629554274 | Rachelle Marie Peterson | Occupational Therapist | 914 S Scheuber Rd, Centralia, WA 98531-9027 | 2018-07-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306462205 | Jelisa Renae Thomas | Counselor | 3510 Steelhammer Ln, Centralia, WA 98531 | 2020-06-17 |
| 1205498607 | Jennifer Kristine Mcglynn Paterno | Counselor | 2428 W. Reynods Ave, Centralia, WA 98531 | 2019-07-05 |
| 1538646328 | Adam Jeffrey Moore | Counselor | 3510 Steelhammer Lane, Centralia, WA 98531 | 2018-07-24 |
| 1144706698 | Euijeong Kim | Occupational Therapist | Rehabilitation Therapies, 914 S. Scheuber Rd, Centralia, WA 98531 | 2018-07-18 |
| 1104315266 | Margaret Fowler Floyd | Registered Nurse | Centralia High School, 813 Eshom Road, Centralia, WA 98531 | 2018-05-04 |
| 1124545777 | Samantha Michelle Moody | Speech-Language Pathologist | Centralia School District, 2320 Borst Ave, Centralia, WA 98531 | 2017-08-24 |
| 1821520289 | Alexa Franks | Behavior Technician | 2428 West Reynolds Ave., Centralia, WA 98531 | 2017-04-03 |
| 1023559861 | Brandy Michelle Peterson | Counselor | 135 W. Main Steet, Centralia, WA 98531 | 2017-03-13 |
| 1841738812 | Graceful Healing Naturopathic | Naturopath | 219 N Tower Ave, Suite 304, Centralia, WA 98531 | 2017-02-09 |
| 1043681513 | Angela Naillon | Counselor | 2428 West Reynolds, Centralia, WA 98531 | 2015-10-09 |
| Find all providers in zip 98531 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275558249 | Bradley C Stufflebam | Radiology | 629 Sable Dr, Centralia, IL 62801-4472 | 2006-07-12 |
| 1801882915 | Southwest Washington Diagnostics Lp | Radiology | 910 S Scheuber Rd, Centralia, WA 98531-9027 | 2005-09-23 |
| 1699108142 | California Advanced Imaging Medical Assoc, Inc. | Radiology | 910 S Scheuber Rd, Centralia, WA 98531-9027 | 2013-08-19 |
| 1043453707 | B C Stufflebam, Md, LLC | Radiology | 629 Sable Dr, Centralia, IL 62801-4472 | 2009-04-10 |
| 1679632970 | Robert J Killian | Radiology | 400 N Pleasant Ave, Radiology Dept, Centralia, IL 62801-3056 | 2006-12-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790325710 | Proliance Surgeons, Inc., P.s. | Radiology | 1101 Madison St Ste 580, Seattle, WA 98104-4305 | 2020-01-07 |
| 1447711544 | Ashkan Jonathan Ahmadian | Radiology | 1959 Ne Pacific Street Radiology Department Rr 210, Seattle, WA 98195-1019 | 2019-03-29 |
| 1639653017 | Radia Imaging Center Holdings LLC | Radiology | 1229 Madison St Ste 900, Seattle, WA 98104-1391 | 2018-09-20 |
| 1427546597 | Kiet Van Vo | Radiology | 1959 Ne Pacific St # 357115, Seattle, WA 98195-0001 | 2018-04-24 |
| 1730605965 | Bellingham Advanced Medical Imaging LLC | Radiology | 1344 King St Ste 101, Bellingham, WA 98229-6215 | 2017-08-18 |
| 1184140477 | Proliance Surgeons, Inc., P.s. | Radiology | 6808 220th St Sw Ste 105, Mountlake Terrace, WA 98043-2187 | 2017-08-17 |
| 1003367863 | Providence Health & Services Washington | Radiology | 4800 College St Se Ste E, Lacey, WA 98503-4389 | 2016-10-17 |
| 1861846057 | Ethan Hua | Radiology | Radiology Department Rr 210 1959 Ne Pacific, Seattle, WA 98195-0001 | 2016-04-14 |
| 1437537354 | Mahmood Albahhar | Radiology | 4245 Roosevelt Way Ne Box 354755, University of Washington Medical Center, Seattle, WA 98105 | 2015-05-12 |
| 1336533991 | Keegan Hovis | Radiology | 1959 Ne Pacific Street Radiology Department, Seattle, WA 98195-3358 | 2015-03-22 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on SOUTH SOUND RADIOLOGY - LEWIS COUNTY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.