Provider Demographics
NPI:1083912257
Name:WASHINGTON STATE DEPARTMENT OF HEALTH
Entity Type:Organization
Organization Name:WASHINGTON STATE DEPARTMENT OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. SECRETARY FINANCIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-236-4503
Mailing Address - Street 1:1610 NE 150TH ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-7224
Mailing Address - Country:US
Mailing Address - Phone:206-418-5400
Mailing Address - Fax:206-418-5445
Practice Address - Street 1:1610 NE 150TH ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-7224
Practice Address - Country:US
Practice Address - Phone:206-418-5400
Practice Address - Fax:206-418-5445
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASHINGTON STATE DEPARTMENT OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMTSA.FS.00001327291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA50D0661543OtherCLIA