Provider Demographics
NPI:1245383348
Name:SEATTLE CHILDREN'S HOSPITAL
Entity Type:Organization
Organization Name:SEATTLE CHILDREN'S HOSPITAL
Other - Org Name:SEATTLE CHILDREN'S HOME CARE SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:V.P. AND CFO
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-987-2004
Mailing Address - Street 1:PO BOX 5371
Mailing Address - Street 2:RC-504
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5005
Mailing Address - Country:US
Mailing Address - Phone:206-987-5770
Mailing Address - Fax:206-987-5779
Practice Address - Street 1:2525 220TH ST SE
Practice Address - Street 2:#101
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-4440
Practice Address - Country:US
Practice Address - Phone:206-987-5398
Practice Address - Fax:206-987-5779
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEATTLE CHILDREN'S HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-19
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH-014251F00000X, 332BP3500X, 3336H0001X
WAIHS.FS,00000097332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6027957Medicaid
WA7331689Medicaid
WA6027957Medicaid