Healthcare Provider Details

I. General information

NPI: 1871538488
Provider Name (Legal Business Name): CARDIAC NUCLEAR MEDICINE ASSOCIATES, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 E KINCAID ST
MOUNT VERNON WA
98274-4126
US

IV. Provider business mailing address

819 S 13TH ST
MOUNT VERNON WA
98274-4112
US

V. Phone/Fax

Practice location:
  • Phone: 360-416-8455
  • Fax: 360-416-8454
Mailing address:
  • Phone: 360-416-8455
  • Fax: 360-416-8454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StateWA

VIII. Authorized Official

Name: JULIE A GADBOIS
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 360-336-9757