Provider Demographics
NPI:1285827097
Name:SEATTLE KING COUNTY DEPT OF PUBLIC HEALTH
Entity Type:Organization
Organization Name:SEATTLE KING COUNTY DEPT OF PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGEMENT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:ARDELL
Authorized Official - Last Name:MOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-263-8807
Mailing Address - Street 1:401 5TH AVE # 1200
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2333
Mailing Address - Country:US
Mailing Address - Phone:206-263-8673
Mailing Address - Fax:
Practice Address - Street 1:401 5TH AVE # 1200
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2333
Practice Address - Country:US
Practice Address - Phone:206-263-8673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KING COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-24
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7095813Medicaid