1376642298 NPI number — SEATTLE EMERGENCY PHYSICIANS SERVICES INC PS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376642298 NPI number — SEATTLE EMERGENCY PHYSICIANS SERVICES INC PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEATTLE EMERGENCY PHYSICIANS SERVICES INC PS
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:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376642298
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
747 BROADWAY
Provider Second Line Business Mailing Address:
SWEDISH HOSPITAL EMERGENCY DEPARTMENT
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98122-4379
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-386-2573
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16410 84TH ST NE
Provider Second Line Business Practice Location Address:
SUITE D-605
Provider Business Practice Location Address City Name:
LAKE STEVENS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98258-9060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-658-2488
Provider Business Practice Location Address Fax Number:
877-501-9769
Provider Enumeration Date:
09/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JEFFERY
Authorized Official First Name:
DINNETTE
Authorized Official Middle Name:
THERESE
Authorized Official Title or Position:
PRACTICE MANAGEMENT
Authorized Official Telephone Number:
360-658-2488

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7007578 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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