Basic Information
| Provider Information | |||||||||
| NPI: | 1134668551 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEATTLE CHILDREN'S HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5371 | ||||||||
| Address2: | RC-504 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981455005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069872000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4800 SAND POINT WAY NE | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981053901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069872000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2017 | ||||||||
| LastUpdateDate: | 02/17/2017 | ||||||||
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| AuthorizedOfficialLastName: | WALLACE | ||||||||
| AuthorizedOfficialFirstName: | KELLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | SVP AND CFO | ||||||||
| AuthorizedOfficialTelephone: | 2069872004 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | H-014 | WA | Y | Agencies | Case Management |
ID Information
| ID | Type | State | Issuer | Description | 1011158 | 05 | WA | MEDICAID |