Provider Demographics
NPI:1134511686
Name:VIRGINIA MASON MEDICAL CENTER
Entity Type:Organization
Organization Name:VIRGINIA MASON MEDICAL CENTER
Other - Org Name:VM SLEEP DURABLE MEDICAL EQUIPMENT SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, VMMC ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERSANTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-341-1208
Mailing Address - Street 1:1100 9TH AVE
Mailing Address - Street 2:MS:M4-PFS
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2756
Mailing Address - Country:US
Mailing Address - Phone:206-515-5811
Mailing Address - Fax:206-341-0274
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:MS-H10SLP
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-625-7180
Practice Address - Fax:203-341-0447
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIRGINIA MASON MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-20
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH-010332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies