Healthcare Provider Details

I. General information

NPI: 1083990261
Provider Name (Legal Business Name): COASTAL SPECIALTY IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 N H ST 5TH FLOOR
ABERDEEN WA
98520-2521
US

IV. Provider business mailing address

PO BOX 1898
ABERDEEN WA
98520-0315
US

V. Phone/Fax

Practice location:
  • Phone: 360-537-6450
  • Fax: 360-537-6451
Mailing address:
  • Phone: 360-533-1576
  • Fax: 360-637-8732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CAREY MARTENS
Title or Position: DOCTOR
Credential: DO
Phone: 360-537-6450