1033699988 NPI number — SEATTLE EXTRACORPOREAL LLC

Table of content: MS. MICHELLE MONIQUE BALTER RN (NPI 1861914533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033699988 NPI number — SEATTLE EXTRACORPOREAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEATTLE EXTRACORPOREAL LLC
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:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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NPI Number Information

NPI Number:
1033699988
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
524 5TH AVE W APT 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98119-3942
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-918-5662
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 9TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98101-2756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-223-6600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LATOUSEK
Authorized Official First Name:
KRIS
Authorized Official Middle Name:
Authorized Official Title or Position:
PERFUSIONIST
Authorized Official Telephone Number:
206-391-9822

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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