MEDICARE: PACIFIC VASCULAR INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	293D00000X	Physiological Laboratory

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295145894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC VASCULAR INCORPORATED

Provider Business Mailing Address
First Line	:	11714 N CREEK PKWY N STE 100
Second Line	:
City	:	BOTHELL
State	:	WA
Zip	:	98011-8250
Country	:	US
Telephone Number	:	425-486-8868
Fax Number	:	425-486-8976

Provider Business Practice Location Address
First Line	:	3104 SQUALICUM PKWY
Second Line	:	SUITE 102
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-1941
Country	:	US
Telephone Number	:	360-733-8128
Fax Number	:	425-486-8976

Authorized Official
Title or Position	:	CEO
Name	:	BONNIE M BROWN
Credential	:	RVT
Telephone Number	:	425-398-7781

Provider Enumeration Date	:	05/05/2014
Last Update Date	:	12/02/2025

Similar Medicare Providers

1780617399 — NORTHWEST VEIN CENTER, PLLC
Practice Location Address:

3104 SQUALICUM PKWY STE 101
BELLINGHAM, WA
98225-1941

Practice Phone: 360-733-2557
Practice Fax: 360-733-4674

1073662508 — ORVILLE KEITH VANDERGRIEND M.D.
Practice Location Address:

3104 SQUALICUM PKWY , SUITE 101
BELLINGHAM, WA
98225-1941

Practice Phone: 360-733-2557
Practice Fax: 360-733-4674

1194919241 — NORTHWEST SURGICAL ASOCIATES
Practice Location Address:

3104 SQUALICUM PKWY
BELLINGHAM, WA
98225-1941

Practice Phone: 206-542-7118
Practice Fax: 206-542-7338

1922447069 — ROBERT STANISLAW NIZNIK MD
Practice Location Address:

3104 SQUALICUM PKWY STE 101
BELLINGHAM, WA
98225-1941

Practice Phone: 360-734-9233
Practice Fax: 360-738-8974

1154438000 — NORTHWEST VASCULAR LAB PLLC
Practice Location Address:

3104 SQUALICUM PKWY , SUITE 101
BELLINGHAM, WA
98225-1936

Practice Phone: 360-733-8128
Practice Fax: 360-733-5354

1114102019 — SOUTHERN DIAGNOSTIC SERVICES, INC.
Practice Location Address:

425 W 3RD AVE , SUITE 510
ALBANY, GA
31701-1941

Practice Phone: 229-312-7519
Practice Fax: 229-312-7505

Directions to “PACIFIC VASCULAR INCORPORATED ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.