Basic Information
| Provider Information | |||||||||
| NPI: | 1710105010 | ||||||||
| EntityType: | 2 | ||||||||
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| 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: | BOX 357110 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2066168900 | ||||||||
| FaxNumber: | 2066168911 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2007 | ||||||||
| LastUpdateDate: | 02/25/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | COLLANTES | ||||||||
| AuthorizedOfficialFirstName: | MARCELO | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER LABMED | ||||||||
| AuthorizedOfficialTelephone: | 2066168886 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | H-128 | WA | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 5561754 | 01 | WA | AETNA | OTHER | LABMED | 01 | WA | FIRST CHOICE | OTHER | 5431552006 | 01 | WA | CIGNA | OTHER | 81-0000362 | 01 | WA | PREMERA | OTHER | 13 | 01 | WA | UNIFORM MEDICAL PLAN | OTHER | LABMED | 01 | WA | WPAS | OTHER | UN0216 | 01 | WA | REGENCE | OTHER | 34 | 01 | WA | UNITED HEALTH CARE | OTHER | 7072168 | 05 | WA | MEDICAID |