1033190889 NPI number — SEATTLE HAND SURGERY GROUP PC

Table of content: (NPI 1033190889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033190889 NPI number — SEATTLE HAND SURGERY GROUP PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEATTLE HAND SURGERY GROUP PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SEATTLE HAND REHABILITATION CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033190889
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 BROADWAY
Provider Second Line Business Mailing Address:
SUITE 440
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-292-6252
Provider Business Mailing Address Fax Number:
206-292-7893

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 440
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-292-6252
Provider Business Practice Location Address Fax Number:
206-292-7893
Provider Enumeration Date:
11/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WAGNER
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
F
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
206-292-6252

Provider Taxonomy Codes

  • Taxonomy code: 207XS0106X , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7064116 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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