50D2254930 CLIA NUMBER - PACIFIC NORTHWEST UROLOGY SPECIALISTS PLLC

Laboratory Demographics

CLIA Number: 50D2254930

Facility Name: PACIFIC NORTHWEST UROLOGY SPECIALISTS PLLC

Facility Address:
1401 S LAVENTURE RD
MOUNT VERNON, WA
ZIP 98274
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Facility Phone Number: 360 733-7687

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1346285236

Taxonomy: 207RC0000X - Internal Medicine
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.

CLIA Record

Field Name	Field Value
CLIA Number	50D2254930
LAB Type	Physician Office
Facility Name	PACIFIC NORTHWEST UROLOGY SPECIALISTS PLLC
Street	1401 S LAVENTURE RD
City	MOUNT VERNON
State	WA
ZIP	98274
Phone	360 733-7687
CertificateType	4
CertificateEffectiveDate	6/21/2023
CertificateExpirationDate	4/4/2028
FacilityType	Waiver

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This page was last updated on: 4/23/2024