Provider Demographics
NPI:1477713196
Name:RAINIER OCCUPATIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:RAINIER OCCUPATIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-568-8577
Mailing Address - Street 1:1400 SOUTH JACKSON ST
Mailing Address - Street 2:#24
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2096
Mailing Address - Country:US
Mailing Address - Phone:206-568-8577
Mailing Address - Fax:206-568-3385
Practice Address - Street 1:1400 SOUTH JACKSON ST
Practice Address - Street 2:#24
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2096
Practice Address - Country:US
Practice Address - Phone:206-568-8577
Practice Address - Fax:206-568-3385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA19706261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7108905Medicaid
WAAB26799Medicare PIN