Provider Demographics
NPI:1073621660
Name:SKAGIT VALLEY ULTRASOUND ASSOCIATES
Entity Type:Organization
Organization Name:SKAGIT VALLEY ULTRASOUND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:DEC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-424-6161
Mailing Address - Street 1:1320 E DIVISION
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4196
Mailing Address - Country:US
Mailing Address - Phone:360-424-6161
Mailing Address - Fax:360-848-1167
Practice Address - Street 1:1320 E DIVISION
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4196
Practice Address - Country:US
Practice Address - Phone:360-424-6161
Practice Address - Fax:360-848-1167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7099542Medicaid
WA67103OtherL&I