Basic Information
| Provider Information | |||||||||
| NPI: | 1053359729 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HARBORVIEW MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 34001 | ||||||||
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| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981241001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067443000 | ||||||||
| FaxNumber: | 2067449390 | ||||||||
| Practice Location | |||||||||
| Address1: | 325 9TH AVE | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065205000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 05/20/2021 | ||||||||
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| AuthorizedOfficialLastName: | WALLEY | ||||||||
| AuthorizedOfficialFirstName: | SOMMER | ||||||||
| AuthorizedOfficialMiddleName: | KLEWENO | ||||||||
| AuthorizedOfficialTitleorPosition: | INTERIM CEO | ||||||||
| AuthorizedOfficialTelephone: | 2067443000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | 05/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS0112X | H-029 | WA | N | Ambulatory Health Care Facilities | Clinic/Center | Oral and Maxillofacial Surgery | 273R00000X | H-029 | WA | N | Hospital Units | Psychiatric Unit | 273Y00000X | H-029 | WA | N | Hospital Units | Rehabilitation Unit | 335E00000X | H-029 | WA | N | Suppliers | Prosthetic/Orthotic Supplier | 282N00000X | H-029 | WA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 7111651 | 05 | WA | MEDICAID | 7117468 | 05 | WA | MEDICAID | 9627225 | 05 | WA | MEDICAID | 072934503 | 05 | TX | MEDICAID | 7111644 | 05 | WA | MEDICAID | 7407810 | 05 | WA | MEDICAID | 7600331 | 05 | WA | MEDICAID | 9637653 | 05 | WA | MEDICAID | 3100062 | 05 | WA | MEDICAID | 7111677 | 05 | WA | MEDICAID | 1993385 | 05 | WA | MEDICAID | 7106883 | 05 | WA | MEDICAID | 3018298 | 05 | WA | MEDICAID | 7406515 | 05 | WA | MEDICAID | 072934502 | 05 | TX | MEDICAID | 7407794 | 05 | WA | MEDICAID |