Provider Demographics
NPI:1154438000
Name:NORTHWEST VASCULAR LAB PLLC
Entity type:Organization
Organization Name:NORTHWEST VASCULAR LAB PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TECHNICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:OBRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:RVT
Authorized Official - Phone:360-733-8128
Mailing Address - Street 1:3104 SQUALICUM PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1936
Mailing Address - Country:US
Mailing Address - Phone:360-733-8128
Mailing Address - Fax:360-733-5354
Practice Address - Street 1:3104 SQUALICUM PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1936
Practice Address - Country:US
Practice Address - Phone:360-733-8128
Practice Address - Fax:360-733-5354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4363293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory