Provider Demographics
NPI:1871538488
Name:CARDIAC NUCLEAR MEDICINE ASSOCIATES, L.L.C.
Entity type:Organization
Organization Name:CARDIAC NUCLEAR MEDICINE ASSOCIATES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GADBOIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-336-9757
Mailing Address - Street 1:819 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4112
Mailing Address - Country:US
Mailing Address - Phone:360-416-8455
Mailing Address - Fax:360-416-8454
Practice Address - Street 1:1415 E KINCAID ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4126
Practice Address - Country:US
Practice Address - Phone:360-416-8455
Practice Address - Fax:360-416-8454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB13180Medicare ID - Type UnspecifiedMEDICARE ID