Basic Information
| Provider Information | |||||||||
| NPI: | 1326002049 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UNIVERSITY OF WASHINGTON | ||||||||
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| OtherOrganizationName: | UNIVERSITY OF WASHINGTON MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 24366 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981240366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065980502 | ||||||||
| FaxNumber: | 2065980516 | ||||||||
| Practice Location | |||||||||
| Address1: | 1959 NE PACIFIC ST | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065983300 | ||||||||
| FaxNumber: | 2065980961 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2006 | ||||||||
| LastUpdateDate: | 05/20/2021 | ||||||||
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| AuthorizedOfficialLastName: | HECKER | ||||||||
| AuthorizedOfficialFirstName: | CYNTHIA | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2066682774 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 05/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD0000X | H-128 | WA | N | Ambulatory Health Care Facilities | Clinic/Center | Dental | 273R00000X | H-128 | WA | N | Hospital Units | Psychiatric Unit | 273Y00000X | H-128 | WA | N | Hospital Units | Rehabilitation Unit | 291U00000X | H-128 | WA | N | Laboratories | Clinical Medical Laboratory | 3336C0002X | HF00001058 | WA | N | Suppliers | Pharmacy | Clinic Pharmacy | 282N00000X | H-128 | WA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 4923822 | 01 | WA | NCPDP - UWMC - ROOSEVELT | OTHER | 7089113 | 05 | WA | MEDICAID | 0170851 | 01 | WA | L&I CRNA | OTHER | 7082704 | 05 | WA | MEDICAID | 7117476 | 05 | WA | MEDICAID | 8940597 | 01 | WA | L&I CRIME VICTIMS CRNA | OTHER | 7091846 | 05 | WA | MEDICAID | 9616129 | 05 | WA | MEDICAID | 0025694 | 01 | WA | L&I GENERAL | OTHER | 9007352 | 05 | WA | MEDICAID | 4915849 | 01 | WA | NCPDP-UWMC - PACIFIC | OTHER | 4906888 | 01 | WA | NCPDP - UWMC-HALL HEALTH | OTHER | 7096043 | 05 | WA | MEDICAID | 8852642 | 01 | WA | MEDICARE DENTAL | OTHER | 9636606 | 05 | WA | MEDICAID |