MEDICARE: NORTHWEST VEIN CENTER, PLLC

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	174400000X	Specialist	MD00012705	WA

General Provider Information

NPI Number	:	1780617399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST VEIN CENTER, PLLC

Provider Business Mailing Address
First Line	:	3104 SQUALICUM PKWY STE 101
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-1941
Country	:	US
Telephone Number	:	360-733-2557
Fax Number	:	360-733-4674

Provider Business Practice Location Address
First Line	:	3104 SQUALICUM PKWY STE 101
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-1941
Country	:	US
Telephone Number	:	360-733-2557
Fax Number	:	360-733-4674

Authorized Official
Title or Position	:	MD/OWNER
Name	:	RICHARD J JONES
Credential	:	MD
Telephone Number	:	360-733-2557

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	09/25/2007

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