Healthcare Provider Details

I. General information

NPI: 1225269715
Provider Name (Legal Business Name): SEATTLE CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 07/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4909 25TH AVE NE
SEATTLE WA
98105-4107
US

IV. Provider business mailing address

PO BOX 50020 M/S S-100
SEATTLE WA
98145-5020
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2000
  • Fax: 206-987-3830
Mailing address:
  • Phone: 206-987-2000
  • Fax: 206-987-3830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberH-014
License Number StateWA

VIII. Authorized Official

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