Provider Demographics
NPI:1053697243
Name:NORTHPOINTE IMAGING CENTER, LLC
Entity type:Organization
Organization Name:NORTHPOINTE IMAGING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRUMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:509-232-7223
Mailing Address - Street 1:9425 N NEVADA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1286
Mailing Address - Country:US
Mailing Address - Phone:509-232-7223
Mailing Address - Fax:509-328-5949
Practice Address - Street 1:9425 N NEVADA ST STE 100
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1286
Practice Address - Country:US
Practice Address - Phone:509-232-7223
Practice Address - Fax:509-328-5949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7927292200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes292200000XLaboratoriesDental Laboratory