Provider Demographics
NPI:1780910091
Name:AGILE DX
Entity type:Organization
Organization Name:AGILE DX
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUILENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-853-1712
Mailing Address - Street 1:5114 POINT FOSDICK DR NW # 440
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1733
Mailing Address - Country:US
Mailing Address - Phone:866-304-5630
Mailing Address - Fax:
Practice Address - Street 1:3413 56TH ST NW
Practice Address - Street 2:SUITE C
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-8341
Practice Address - Country:US
Practice Address - Phone:253-853-1712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-21
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No293D00000XLaboratoriesPhysiological Laboratory