1710105010 NPI number — UNIVERSITY OF WASHINGTON

Table of content: (NPI 1710105010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710105010 NPI number — UNIVERSITY OF WASHINGTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF WASHINGTON
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:
UNIVERSITY OF WASHINGTON MEDICAL CENTER
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:
1710105010
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 24366
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:
98124-0366
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-598-0502
Provider Business Mailing Address Fax Number:
206-598-0516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1959 NE PACIFIC ST
Provider Second Line Business Practice Location Address:
BOX 357110
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98195-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-616-8900
Provider Business Practice Location Address Fax Number:
206-616-8911
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COLLANTES
Authorized Official First Name:
MARCELO
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER LABMED
Authorized Official Telephone Number:
206-616-8886

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  H-128 , 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: 5561754 . This is a "AETNA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: LABMED . This is a "FIRST CHOICE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 5431552006 . This is a "CIGNA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 81-0000362 . This is a "PREMERA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 13 . This is a "UNIFORM MEDICAL PLAN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: LABMED . This is a "WPAS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: UN0216 . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 34 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7072168 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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