1790005858 NPI number — UNIVERSITY OF WASHINGTON

Table of content: (NPI 1790005858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790005858 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:
Provider Other Organization Name Type Code:
6
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:
1790005858
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6505 PERIMETER RD S STE 200
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:
98108-3839
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-521-1599
Provider Business Mailing Address Fax Number:
206-521-1612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6505 PERIMETER RD S STE 200
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:
98108-3839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-521-1599
Provider Business Practice Location Address Fax Number:
206-521-1612
Provider Enumeration Date:
06/10/2010

Additional Information

Authorized Official

Authorized Official Last Name:
RICHEY
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
W
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
206-521-1599

Provider Taxonomy Codes

  • Taxonomy code: 3416A0800X , with the licence number:  42X01 , 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: 108794000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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