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A laboratory that operates independently of a hospital and physician?s office to furnish physiological diagnostic services (e.g. EEG?s , EKG?s, scans, etc.). Facilities offering ONLY physiological services are not certified as independent laboratories. If an independent laboratory offers physiological services IN ADDITION to clinical laboratory services, they are surveyed only for compliance with the clinical laboratory regulations because there are no health and safety regulations for physiological services.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Physiological Laboratory, (Independent Physiological Lab) |
293D00000X | 47 | Independent Diagnostic Testing Facility (IDTF) |
| NPI Number | 1154476216 |
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| LBN Legal business name | PACIFIC VASCULAR INCORPORATED | ||||||||
| Authorized official | BONNIE BROWN - (CEO) | ||||||||
| Entity | Organization | ||||||||
| Organization subpart 1 | Yes | ||||||||
| Enumeration date | 01/25/2007 | ||||||||
| Last updated | 12/02/2025 - About 6 months ago | ||||||||
| Identifiers |
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PACIFIC VASCULAR INCORPORATED
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| RONALD BERENSON, MD 2032 41ST AVENUE SEATTLE, WA |
| BRITA M HANSON 301 N BROADWAY ST ABERDEEN, WA |
| STEPHEN P MONTOURE, CDPT 224 E WISHKAH ST ABERDEEN, WA |
| ALEXA MAHAN 18311 BOTHELL-EVERETT HIGHWAY 98012, BOTHELL, WA, WA |
| JAMIE K MCINTYRE, LMT 410 E NORTH BEND WAY 98045, WA |
| JAVON J WILSON, BT 18311 BOTHELL-EVERETT HIGHWAY 98012, BOTHELL, WA, WA |
PACIFIC VASCULAR INCORPORATED