Provider Demographics
NPI:1114472560
Name:UW MEDICINE CENTER FOR PRECISION DIAGNOSTICS
Entity Type:Organization
Organization Name:UW MEDICINE CENTER FOR PRECISION DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:FLANNERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-685-1176
Mailing Address - Street 1:1959 NE PACIFIC ST
Mailing Address - Street 2:HSB H-564, BOX 357655
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-7655
Mailing Address - Country:US
Mailing Address - Phone:206-543-0459
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:HSB H-564, BOX 357655
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-7655
Practice Address - Country:US
Practice Address - Phone:206-543-0459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA50D2093534291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory