Provider Demographics
NPI:1033107214
Name:SWEDISH EDMONDS
Entity Type:Organization
Organization Name:SWEDISH EDMONDS
Other - Org Name:PUBLIC HOSPITAL DISTRICT 2 OF SNOHOMISH COUNTY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR REIMBURSEMENT ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:425-525-5392
Mailing Address - Street 1:PO BOX 271627
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-1627
Mailing Address - Country:US
Mailing Address - Phone:425-640-4000
Mailing Address - Fax:425-640-4432
Practice Address - Street 1:21601 76TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7507
Practice Address - Country:US
Practice Address - Phone:425-640-4000
Practice Address - Fax:425-640-4432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHAC.FS.60183546273R00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA191514500OtherWORKERS COMP FEDERAL
WA6580520OtherAETNA
WAMC150OtherPREMERA BLUE CROSS
WA0065668OtherAETNA
WAW718582OtherCHAMPUS
WAHP150OtherPREMERA BLUE CROSS
WA267677OtherWA STATE LABOR AND INDUSTRY
WA0288OtherREGENCE BLUE SHIELD
WA150OtherPREMERA BLUE CROSS
WA013722001OtherGROUP HEALTH
WA3341807Medicaid
WAST0092OtherREGENCE BLUE SHIELD
WAMC150OtherPREMERA BLUE CROSS