| Breast Diagnostic Center | |
|
1268 E Main St Suite 1 Auburn WA 98002-5748 | |
| (253) 735-1991 | |
| (253) 735-8837 |
| Full Name | Breast Diagnostic Center |
|---|---|
| Speciality | Clinic/center |
| Location | 1268 E Main St, Auburn, Washington |
| Authorized Official Name and Position | John T Blackwelder (PRESIDENT) |
| Authorized Official Contact | 2537351991 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Breast Diagnostic Center 1268 E Main St Suite 1 Auburn WA 98002-5748 Ph: (253) 735-1991 | Breast Diagnostic Center 1268 E Main St Suite 1 Auburn WA 98002-5748 Ph: (253) 735-1991 |
| NPI Number | 1811005861 |
|---|---|
| Provider Enumeration Date | 08/29/2006 |
| Last Update Date | 07/17/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811005861 | NPI | - | NPPES |
| 7117252 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 602300908 (Washington) | Primary |
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