Provider Demographics
NPI:1467512293
Name:MEDICAL DIAGNOSTIC SPECIALTIES, INC.
Entity Type:Organization
Organization Name:MEDICAL DIAGNOSTIC SPECIALTIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:N
Authorized Official - Last Name:THULINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-653-5960
Mailing Address - Street 1:3131 SMOKEY POINT DR
Mailing Address - Street 2:SUITE J
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-4711
Mailing Address - Country:US
Mailing Address - Phone:360-653-5960
Mailing Address - Fax:
Practice Address - Street 1:3131 SMOKEY POINT DR
Practice Address - Street 2:SUITE J
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-4711
Practice Address - Country:US
Practice Address - Phone:360-653-5960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0067046OtherLABOR & IND. STANLEY
WAR23416OtherBLUE CROSS - STANLEY
WA0067045OtherLABOR & IND. - THULINE
WA1831205Medicaid
WAR12468OtherBLUE CROSS - THULINE
WA0067046OtherLABOR & IND. STANLEY
WAD83299Medicare UPIN