Provider Demographics
NPI:1003251042
Name:ASSOCIATION OF UNIVERSITY PHYSICIANS
Entity Type:Organization
Organization Name:ASSOCIATION OF UNIVERSITY PHYSICIANS
Other - Org Name:UNIVERSITY OF WASHINGTON PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOELKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-616-1024
Mailing Address - Street 1:PO BOX 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:206-543-6420
Mailing Address - Fax:206-520-5620
Practice Address - Street 1:23213 PACIFIC HWY S
Practice Address - Street 2:UWNC KENT-DES MOINES CLINIC
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-2721
Practice Address - Country:US
Practice Address - Phone:206-543-6420
Practice Address - Fax:206-520-5620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-03
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA104100000X, 133V00000X, 207Q00000X, 207R00000X, 208000000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAUP1000Medicare PIN
WAAB07275Medicare PIN