Healthcare Provider Details

I. General information

NPI: 1124334248
Provider Name (Legal Business Name): SWEDISH EDMONDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2010
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21601 76TH AVE W
EDMONDS WA
98026-7507
US

IV. Provider business mailing address

PO BOX 91000
EDMONDS WA
98026-2100
US

V. Phone/Fax

Practice location:
  • Phone: 425-640-4740
  • Fax: 425-640-4746
Mailing address:
  • Phone: 425-640-4740
  • Fax: 425-640-4746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DONALD WAYNE ANDERSON JR.
Title or Position: ASSISTANT SECREATRY FOR ENROLLMENT
Credential:
Phone: 425-358-9786