Basic Information
| Provider Information | |||||||||
| NPI: | 1528203551 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEATTLE CHILDREN'S HOSPITAL | ||||||||
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| OtherOrganizationName: | PEDIATRIC CARDIOLOGY OF ALASKA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 5371 | ||||||||
| Address2: | RC-504 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981243867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069875778 | ||||||||
| FaxNumber: | 2069875779 | ||||||||
| Practice Location | |||||||||
| Address1: | 3260 PROVIDENCE DR | ||||||||
| Address2: | SUITE 321 | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995084661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069872000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2008 | ||||||||
| LastUpdateDate: | 09/28/2018 | ||||||||
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| AuthorizedOfficialLastName: | BEITEL | ||||||||
| AuthorizedOfficialFirstName: | SUZANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | V.P. AND CFO | ||||||||
| AuthorizedOfficialTelephone: | 2069874153 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SEATTLE CHILDREN'S HOSPITAL | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0202X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | 261QM2500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
No ID Information.