Healthcare Provider Details

I. General information

NPI: 1730199886
Provider Name (Legal Business Name): UW MEDICINE NORTHWEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 NORTH 115TH STREET
SEATTLE WA
98133-9733
US

IV. Provider business mailing address

1550 NORTH 115TH STREET
SEATTLE WA
98133-9733
US

V. Phone/Fax

Practice location:
  • Phone: 206-364-0500
  • Fax: 206-368-3029
Mailing address:
  • Phone: 206-364-0500
  • Fax: 206-368-3029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License NumberH-130HAC.FS00000130
License Number StateWA

VIII. Authorized Official

Name: MR. BRUCE FERGUSON
Title or Position: VP/CHIEF FINANCIAL OFFICER
Credential:
Phone: 206-368-1700