Provider Demographics
NPI:1366634503
Name:SISTERS OF PROVIDENCE IN WASHINGTON
Entity Type:Organization
Organization Name:SISTERS OF PROVIDENCE IN WASHINGTON
Other - Org Name:PROVIDENCE MOUNT SAINT VINCENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLLMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-254-5403
Mailing Address - Street 1:4831 35TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-2709
Mailing Address - Country:US
Mailing Address - Phone:206-937-3700
Mailing Address - Fax:206-938-8999
Practice Address - Street 1:4831 35TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-2709
Practice Address - Country:US
Practice Address - Phone:206-937-3700
Practice Address - Fax:206-938-8999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA77261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9042979Medicaid