Provider Demographics
NPI:1093771289
Name:ADVANCED PERIPHERAL VASCULAR DIAGNOSTICS INC
Entity Type:Organization
Organization Name:ADVANCED PERIPHERAL VASCULAR DIAGNOSTICS INC
Other - Org Name:SOUND DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:ARMS, RDCS
Authorized Official - Phone:425-252-4000
Mailing Address - Street 1:PO BOX 1480
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-1480
Mailing Address - Country:US
Mailing Address - Phone:425-252-4000
Mailing Address - Fax:425-438-8666
Practice Address - Street 1:14701 179TH AVE SE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1108
Practice Address - Country:US
Practice Address - Phone:360-791-1447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0096247OtherLABOR & INDUSTRIES
WAGAB09098Medicare ID - Type Unspecified