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General NPI Number Information
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NPI Number | 1396199824
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Entity Type | Organization
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Legal Business Name | SEATTLE EXTRACORPOREAL
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Dates
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Enumeration Date | 04/21/2016
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Last Update Date | 04/21/2016
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Provider Practice Location Address
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Address Line | 925 SENECA STREET SEATTLE EXTRACORPOREAL
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City | SEATTLE
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State | WA
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Zip | 98101
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Country | US
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Telephone | 206-223-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 4446 88TH AVE SE
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City | MERCER ISLAND
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State | WA
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Zip | 98040-4148
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Country | US
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Telephone | 206-939-9898
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Fax |
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Authorized Official
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Title or Position | CLINICAL PERFUSIONIST
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Name | MR. RAY LEE JOHNSON
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Credential | CCP
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Telephone | 206-939-9898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 819241
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License Number State | WA
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