Basic Information
| Provider Information | |||||||||
| NPI: | 1225269715 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEATTLE CHILDREN'S HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 50020 | ||||||||
| Address2: | M/S S-100 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981455020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069872000 | ||||||||
| FaxNumber: | 2069873830 | ||||||||
| Practice Location | |||||||||
| Address1: | 4909 25TH AVE NE | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981054107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069872000 | ||||||||
| FaxNumber: | 2069873830 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2009 | ||||||||
| LastUpdateDate: | 07/31/2009 | ||||||||
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| AuthorizedOfficialLastName: | WALLACE | ||||||||
| AuthorizedOfficialFirstName: | KELLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | S.V.P AND CFO | ||||||||
| AuthorizedOfficialTelephone: | 2069872004 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | H-014 | WA | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 3306206 | 05 | WA | MEDICAID |