Provider Demographics
NPI:1639568462
Name:SOUND VASCULAR, P.S.
Entity Type:Organization
Organization Name:SOUND VASCULAR, P.S.
Other - Org Name:NORTHWEST VEIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-874-7107
Mailing Address - Street 1:922 S 348TH ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-7021
Mailing Address - Country:US
Mailing Address - Phone:253-874-7107
Mailing Address - Fax:253-874-1923
Practice Address - Street 1:3104 SQUALICUM PKWY
Practice Address - Street 2:STE 101
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225
Practice Address - Country:US
Practice Address - Phone:360-733-2557
Practice Address - Fax:360-733-4674
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUND VASCULAR, P.S.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-16
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G8893622OtherPTAN