Provider Demographics
NPI:1043428352
Name:SWEDISH EDMONDS
Entity Type:Organization
Organization Name:SWEDISH EDMONDS
Other - Org Name:SWEDISH EDMONDS PSYCHIATRIC SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:S
Authorized Official - Last Name:FARRETTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-673-3374
Mailing Address - Street 1:PO BOX 91000
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-2100
Mailing Address - Country:US
Mailing Address - Phone:425-673-3374
Mailing Address - Fax:425-640-4455
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:425-640-4455
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SWEDISH EDMONDS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-18
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7060486Medicaid
WAGAB36145Medicare PIN
WAG8895546Medicare PIN
WA1053626465Medicare PIN