1700990918 NPI number — WASHINGTON CANCER CENTERS PC

Table of content: (NPI 1700990918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700990918 NPI number — WASHINGTON CANCER CENTERS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WASHINGTON CANCER CENTERS 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:
PUGET SOUND CANCER CENTERS
Provider Other Organization Name Type Code:
5
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:
1700990918
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1560 N 115TH ST
Provider Second Line Business Mailing Address:
G-16
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98133-8414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-362-1577
Provider Business Mailing Address Fax Number:
206-367-7176

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21605 76TH AVE W
Provider Second Line Business Practice Location Address:
STE # 200
Provider Business Practice Location Address City Name:
EDMONDS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98026-7514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-775-1677
Provider Business Practice Location Address Fax Number:
425-778-1635
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PARKINSON
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
425-775-1677

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7083371 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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