Provider Demographics
NPI:1164493847
Name:FRED HUTCHINSON CANCER CENTER
Entity Type:Organization
Organization Name:FRED HUTCHINSON CANCER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-667-6363
Mailing Address - Street 1:825 EASTLAKE AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-4405
Mailing Address - Country:US
Mailing Address - Phone:206-606-6206
Mailing Address - Fax:206-606-6299
Practice Address - Street 1:825 EASTLAKE AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4405
Practice Address - Country:US
Practice Address - Phone:206-606-7222
Practice Address - Fax:206-606-1025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601883375282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM12033782Medicaid
AKHS4751PMedicaid
HP196OtherPREMERA HEALTH PLUS
WA3022936Medicaid
505745003OtherGROUP HEALTH NON BMT
MC196OtherPREMERA HEALTHY OPTIONS
5858SEOtherREGENCE BLUE SHIELD
ID806022900Medicaid
MT412284Medicaid
505745001OtherGROUP HEALTH POST BMT OUT
1141698OtherMERCY HORIZON
149053OtherLABOR & INDUSTRIES
196OtherPREMERA
505745002OtherGROUP HEALTH BMT INPATIEN
ID806022900Medicaid