| Dr Lawrence Northwood Bennett, MD | |
|
3417 Ensign Rd Ne, Olympia, WA 98506-5075 | |
| (360) 493-4600 | |
| (360) 493-4603 |
| Full Name | Dr Lawrence Northwood Bennett |
|---|---|
| Gender | Male |
| Speciality | Radiology - Diagnostic Radiology |
| Location | 3417 Ensign Rd Ne, Olympia, Washington |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053302547 | NPI | - | NPPES |
| 1042650 | Medicaid | WA | |
| 0117641 | Other | WA | LNI-SOUTH SOUND |
| 8213712 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2085R0202X | Radiology - Diagnostic Radiology | MD00035569 (Washington) | Primary |
| Entity Name | Radia Imaging Center Holdings Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1639653017 PECOS PAC ID: 6305182965 Enrollment ID: O20190118000572 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Lawrence Northwood Bennett, MD 19020 33rd Ave W Ste 210, Lynnwood, WA 98036-4748 Ph: (425) 563-1500 | Dr Lawrence Northwood Bennett, MD 3417 Ensign Rd Ne, Olympia, WA 98506-5075 Ph: (360) 493-4600 |
Dr. Kevin Joseph Reed, M.D. Radiology Medicare: Not Enrolled in Medicare Practice Location: 3417 Ensign Rd Ne, Olympia, WA 98506 Phone: 360-493-4609 Fax: 360-493-4603 | |
Dr. Samuel J. Boynton, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 3417 Ensign Rd Ne, Olympia, WA 98506 Phone: 360-493-4600 Fax: 360-493-4603 | |
Dr. Tariq Hesham Balawi, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 3417 Ensign Rd Ne, Olympia, WA 98506 Phone: 360-493-4600 Fax: 360-493-4603 | |
Dr. Jabi Elijah Shriki, M.D. Radiology Medicare: Not Enrolled in Medicare Practice Location: 3417 Ensign Road Ne, Olympia, WA 98506 Phone: 360-493-4609 Fax: 360-493-4603 | |
Dr. Jack Mark Fields, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 3417 Ensign Rd Ne, Olympia, WA 98506 Phone: 360-493-4600 Fax: 360-493-4603 | |
Dr. Christopher Brinson Hartness, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 413 Lilly Rd Ne, Olympia, WA 98506 Phone: 604-937-4603 Fax: 360-493-7253 |