NPIMap

Organization Active NPI

Pacific Vascular Incorporated

  • Physiological Laboratory
  • Port Orchard, WA
National Provider Identifier
1730085754
Registry record updated Oct 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physiological LaboratoryTaxonomy code 293D00000X
Legal business name
PACIFIC VASCULAR INCORPORATED
Practice address
463 Tremont St W Ste 120
Port Orchard, WA 98366-3743
Phone
(425) 486-8868
Fax
(425) 486-8976
NPI assigned
Oct 16, 2026
Last updated
Oct 16, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
PACIFIC VASCULAR INCORPORATEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 16, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Bonnie Marie Brown, RVT
Title
Ceo
Phone
(425) 398-7781

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physiological Laboratory 293D00000X Primary

Addresses

Primary practice location

463 Tremont St W Ste 120
Port Orchard, WA 98366-3743

Mailing address

11714 N Creek Pkwy N Ste 100
Bothell, WA 98011-8250
Phone (425) 486-8868

Other identifiers 1

IdentifierTypeStateIssuer
7015852MedicaidWA

National Provider Directory

National Provider Directory
Tax ID family
Pacific Vascular16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1792108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1792108800000",
    "number": "1730085754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11714 N CREEK PKWY N STE 100",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980118250",
            "telephone_number": "425-486-8868",
            "fax_number": "425-486-8976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "463 TREMONT ST W STE 120",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "983663743",
            "telephone_number": "425-486-8868",
            "fax_number": "425-486-8976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC VASCULAR INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PACIFIC VASCULAR INCORPORATED",
        "enumeration_date": "2026-10-16",
        "last_updated": "2026-10-16",
        "certification_date": "2026-10-16",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "BONNIE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "425-398-7781",
        "authorized_official_credential": "RVT"
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7015852",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orchard, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.