Provider Demographics
NPI:1083990261
Name:COASTAL SPECIALTY IMAGING
Entity Type:Organization
Organization Name:COASTAL SPECIALTY IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTENS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:360-537-6450
Mailing Address - Street 1:PO BOX 1898
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-0315
Mailing Address - Country:US
Mailing Address - Phone:360-533-1576
Mailing Address - Fax:360-637-8732
Practice Address - Street 1:1006 N H ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-2521
Practice Address - Country:US
Practice Address - Phone:360-537-6450
Practice Address - Fax:360-537-6451
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 Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty