Healthcare Provider Details

I. General information

NPI: 1780910091
Provider Name (Legal Business Name): AGILE DX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2009
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3413 56TH ST NW SUITE C
GIG HARBOR WA
98335-8341
US

IV. Provider business mailing address

5114 POINT FOSDICK DR NW # 440
GIG HARBOR WA
98335-1733
US

V. Phone/Fax

Practice location:
  • Phone: 253-853-1712
  • Fax:
Mailing address:
  • Phone: 866-304-5630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. SEAN MUILENBURG
Title or Position: PRESIDENT/CEO
Credential:
Phone: 253-853-1712