Healthcare Provider Details

I. General information

NPI: 1811041692
Provider Name (Legal Business Name): SEATTLE CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 206-987-5770
  • 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 Code174400000X
TaxonomySpecialist
License NumberH-014
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License NumberH-014
License Number StateWA

VIII. Authorized Official

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