Healthcare Provider Details

I. General information

NPI: 1245383348
Provider Name (Legal Business Name): SEATTLE CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 220TH ST SE #101
BOTHELL WA
98021-4440
US

IV. Provider business mailing address

PO BOX 5371 RC-504
SEATTLE WA
98145-5005
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-5398
  • Fax: 206-987-5779
Mailing address:
  • Phone: 206-987-5770
  • Fax: 206-987-5779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberIHS.FS,00000097
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberH-014
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberIHS.FS,00000097
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberH-014
License Number StateWA
# 5
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License NumberH-014
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6027957
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 2
Identifier7331689
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name: KELLY WALLACE
Title or Position: V.P. AND CFO
Credential:
Phone: 206-987-2004