Organization Name: | PACIFIC VASCULAR, INC |
NPI Number: | 1730534553 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PAUL OLMSTED (CEO,CFO) |
Mailing Address: | 11714 N Creek Pkwy N Suite 100 Bothell |
State: | WA US |
Postal Code: | 980118250 |
Phone Number: | 4254868868 |
Fax Number: | 4254868976 |
NPI Enumeration Date: | 04/29/2016 |
NPI Last Update Date: | 04/29/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 293D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Laboratories |
Taxonomy Classification: | Physiological Laboratory |
Taxonomy Specialization: | |
Taxonomy Definition: | A laboratory that operates independently of a hospital and physician |