For individual NPIs the license data is associated to the taxonomy code.
There could be only one primary taxonomy code per NPI record. The primary taxonomy code defines the provider type, classification, and specialization. The date that a NPI record was last updated or changed. The date the provider was assigned a unique identifier (assigned an NPI). The provider other organization name codes are: The code identifying the type of other name. The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component. Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. Subparts are the components and separate physical locations of organization health care providers.
The CLIA number of Evergreen Radia is 50D1099043 registered as a "other practitioner" facility with a CLIA Certificate of Waiver. The authorized official of this NPI record is Lloyd Stambaugh Md (President)
The provider's is doing business as Evergreen Radia.
Evergreen Radia (evergreen Radia Llc) operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The provider is registered as an organization and their NPI record was last updated 4 years ago.
The practitioner's primary taxonomy code is 2085R0202X with license number 602317167 (WA). The NPI number of Evergreen Radia (evergreen Radia Llc) is 1922095694 and was assigned on September 2005. NPI 1922095694 Organization Radiology Diagnostic Radiology CLIA Number 50D1099043 CLIA Certificate of Waiver About EVERGREEN RADIA (EVERGREEN RADIA LLC)Įvergreen Radia (evergreen Radia Llc) is a provider established in Kirkland, Washington specializing in radiology (diagnostic radiology).