Provider Demographics
NPI:1497766067
Name:UW MEDICINE NORTHWEST
Entity Type:Organization
Organization Name:UW MEDICINE NORTHWEST
Other - Org Name:NORTHWEST HOSPTIAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-368-1700
Mailing Address - Street 1:1550 NORTH 115TH STREET
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9733
Mailing Address - Country:US
Mailing Address - Phone:206-364-0500
Mailing Address - Fax:206-368-3029
Practice Address - Street 1:1550 NORTH 115TH STREET
Practice Address - Street 2:MAIL STOP PZ 506
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9733
Practice Address - Country:US
Practice Address - Phone:206-364-0500
Practice Address - Fax:206-368-3029
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UW MEDICINE NORTHWEST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-10
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
273R00000X
WAH-130HAC.FS.00000130273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3500220Medicaid
50-5001Medicare UPIN
WA3500220Medicaid