Healthcare Provider Details

I. General information

NPI: 1033288444
Provider Name (Legal Business Name): SEATTLE CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 11/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MADISON ST SUITE 550
SEATTLE WA
98104-1306
US

IV. Provider business mailing address

PO BOX 5371 W-4657
SEATTLE WA
98105-0371
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-6100
  • Fax: 206-386-6332
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberH-014
License Number StateWA

VIII. Authorized Official

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