Provider Demographics
NPI:1033699988
Name:SEATTLE EXTRACORPOREAL LLC
Entity Type:Organization
Organization Name:SEATTLE EXTRACORPOREAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERFUSIONIST
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LATOUSEK
Authorized Official - Suffix:
Authorized Official - Credentials:CCP
Authorized Official - Phone:206-391-9822
Mailing Address - Street 1:524 5TH AVE W APT 100
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-3942
Mailing Address - Country:US
Mailing Address - Phone:864-918-5662
Mailing Address - Fax:
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-223-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty