Provider Demographics
NPI:1548219785
Name:SEDRO WOOLLEY EMERGENCY PHYSICIANS
Entity Type:Organization
Organization Name:SEDRO WOOLLEY EMERGENCY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:T
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-230-5160
Mailing Address - Street 1:PO BOX 8459
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-8459
Mailing Address - Country:US
Mailing Address - Phone:805-563-3011
Mailing Address - Fax:805-564-5087
Practice Address - Street 1:2000 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-4327
Practice Address - Country:US
Practice Address - Phone:360-856-7110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-06
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADE1146OtherRAILROAD MEDICARE
WA7122948Medicaid
WA=========OtherBLUE CROSS
WA7122948Medicaid
WA8857226Medicare PIN