PACIFIC VASCULAR INCORPORATED (NPI# 1508911686) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508911686 |
| Entity Type | Organization |
| Organization Name | PACIFIC VASCULAR INCORPORATED |
| Other Organization Name | ST. CLARE HOSPITAL - PVI VASCULAR LABORATORY |
| Practice Address |
11311 Bridgeport Way Sw Suite 108 Tacoma WA 98499-3071 |
| Mailing Address |
11714 N Creek Pkwy N Suite 100 Bothell WA 98011-8250 |
| Practice Telephone | 2535816405 |
| Practice Fax Number | 2539848272 |
| Mailing Telephone | 4254868868 |
| Mailing Fax Number | 4254868976 |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2009-10-27 |
| Authorized Official Name | FRANKLIN W. WEST (DIRECTOR OF PROFESSIONAL SERVICES) |
| Authorized Official Telephone | 4253987774 |
| Authorized Official Credential | BSN RN RVT RVS C |
| Is Organization Subpart | Y |
| Parent Organization Name | PACIFIC VASCULAR INCORPORATED |
| Parent Organization TIN |
|
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 293D00000X | Physiological Laboratory | Laboratories |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 7015852 | 05 |
| Other Name | Type Code |
|---|---|
| St. Clare Hospital - PVI Vascular Laboratory | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639776842 | Pacific Vascular Incorporated | Physiological Laboratory | 315 E 8th St Lowr Level, Port Angeles, WA 98362-6217 | 2020-10-01 |
| 1891017992 | Pacific Vascular Incorporated | Physiological Laboratory | 536 N 5th Ave, Suite B, Sequim, WA 98382-3079 | 2010-02-17 |
| 1376904078 | Pacific Vascular Incorporated | Physiological Laboratory | 1 E Main St, Suite 120, Auburn, WA 98002-4905 | 2016-03-09 |
| 1295145894 | Pacific Vascular Incorporated | Physiological Laboratory | 3104 Squalicum Pkwy, Suite 102, Bellingham, WA 98225-1941 | 2014-05-05 |
| 1619300308 | Pacific Vascular Incorporated | Physiological Laboratory | 11714 N Creek Pkwy N Ste 100, Bothell, WA 98011-8250 | 2013-08-16 |
| 1952608531 | Pacific Vascular Incorporated | Physiological Laboratory | 7315 212th St Sw, Suite 201a, Edmonds, WA 98026-7610 | 2011-02-17 |
| 1750615696 | Pacific Vascular Incorporated | Physiological Laboratory | 3999 Englewood Ave, Suite 203, Yakima, WA 98902-6334 | 2009-09-24 |
| 1043365257 | Pacific Vascular Incorporated | Physiological Laboratory | 1 E Main St, Suite 120, Auburn, WA 98002-4905 | 2007-01-25 |
| 1154476216 | Pacific Vascular Incorporated | Physiological Laboratory | 1600 E Jefferson St, Suite 201, Seattle, WA 98122-5698 | 2007-01-25 |
| 1295880433 | Pacific Vascular Incorporated | Physiological Laboratory | 1229 Madison St, Suite 810, Seattle, WA 98104-3586 | 2007-01-25 |
| Street Address |
11311 BRIDGEPORT WAY SW SUITE 108 |
| City | TACOMA |
| State | WA |
| Zip Code | 98499-3071 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275159592 | Sea Mar Community Health Centers | Clinic/Center | 5700 100th Street Se, Suite 510, Lakewood, WA 98499 | 2020-06-23 |
| 1568018828 | Heather Leigh Andrade | Behavioral Analyst | 6210 75th St W Ste 100, Lakewood, WA 98499 | 2019-08-13 |
| 1043870876 | Seoul Chinese Herbs Inc | Acupuncturist | 8705 S. Tacoma Way, Lakewood, WA 98499 | 2019-06-14 |
| 1013572064 | Puget Sound Kidney Centers | Clinic/Center | 11950 47th Ave Sw, Lakewood, WA 98499 | 2019-05-06 |
| 1447736657 | Marcela Cunan | Counselor | 9330 59th Avenue Southest, Lakewood, WA 98499 | 2018-07-11 |
| 1609382381 | Leroy Moore IIi | Counselor | 8811 S. Tacoma Way, 106, Lakewood, WA 98499 | 2017-12-18 |
| 1578077657 | Andrea Gaston | Behavior Technician | 8815 S. Tacoma Way, Suite 122, Lakewood, WA 98499 | 2017-11-27 |
| 1609389931 | Jennifer King | Social Worker | 5900 100th St Sw Ste 17b, Lakewood, WA 98499 | 2017-11-08 |
| 1750806337 | Wonyoung Lee | Counselor | 8811 South Tacoma Way, Suite 106, Lakewood, WA 98499 | 2017-08-04 |
| 1043749443 | Frederick Paltron Edwards | Counselor | 9500 Front Street, Suite 100, Lakewood, WA 98499 | 2017-06-08 |
| Find all providers in zip 98499 | ||||
| Taxonomy Code | 293D00000X |
| Grouping | Laboratories |
| Classification | Physiological Laboratory |
| A laboratory that operates independently of a hospital and physician’s office to furnish physiological diagnostic services (e.g. EEG’s , EKG’s, scans, etc.). Facilities offering ONLY physiological services are not certified as independent laboratories. If an independent laboratory offers physiological services IN ADDITION to clinical laboratory services, they are surveyed only for compliance with the clinical laboratory regulations because there are no health and safety regulations for physiological services. |
| Notes: Source: Paraphrased from the Medicare Carrier Manual, Section 2070.5. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235432741 | Med-men LLC | Physiological Laboratory | 2522 N Proctor St, 468, Tacoma, WA 98406-5338 | 2010-12-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639776842 | Pacific Vascular Incorporated | Physiological Laboratory | 315 E 8th St Lowr Level, Port Angeles, WA 98362-6217 | 2020-10-01 |
| 1700329828 | Braincare, LLC | Physiological Laboratory | 19909 120th Ave Ne Ste 203, Bothell, WA 98011-8242 | 2016-11-21 |
| 1952777427 | Ronald Berenson | Physiological Laboratory | 2032 41st Avenue, Seattle, WA 98112 | 2015-08-19 |
| 1851715130 | Greater Sleep Solutions | Physiological Laboratory | 18801 Veterans Memorial Dr E Ste 1, Bonney Lake, WA 98391-5204 | 2014-02-07 |
| 1891017992 | Pacific Vascular Incorporated | Physiological Laboratory | 536 N 5th Ave, Suite B, Sequim, WA 98382-3079 | 2010-02-17 |
| 1780910091 | Agile Dx | Physiological Laboratory | 3413 56th St Nw, Suite C, Gig Harbor, WA 98335-8341 | 2009-10-21 |
| 1942441571 | Daniel Anyimah | Physiological Laboratory | 19604 Bing Road, Lynnwood, WA 98036 | 2009-03-11 |
| 1588600571 | Alpha Omega Sonography LLC | Physiological Laboratory | 12402 N Division St, Suite 205, Spokane, WA 99218-1930 | 2006-06-20 |
| 1053865220 | Pacific Vascular, Inc | Physiological Laboratory | 11714 N Creek Pkwy N, Suite 100, Bothell, WA 98011-8250 | 2016-08-05 |
| 1730534553 | Pacific Vascular, Inc | Physiological Laboratory | 11714 N Creek Pkwy N, Suite 100, Bothell, WA 98011-8250 | 2016-04-29 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on PACIFIC VASCULAR INCORPORATED.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.