Provider Demographics
NPI:1598783318
Name:PROVIDENCE EVERETT MEDICAL CENTER
Entity Type:Organization
Organization Name:PROVIDENCE EVERETT MEDICAL CENTER
Other - Org Name:PROVIDENCE MATERNAL-FETAL MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIR REVENUE CYCLE MGMT NWSA
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOBAYASHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-317-0186
Mailing Address - Street 1:909 N BROADWAY
Mailing Address - Street 2:PBO CREDENTIALING
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-1409
Mailing Address - Country:US
Mailing Address - Phone:425-317-0699
Mailing Address - Fax:425-317-0291
Practice Address - Street 1:900 PACIFIC AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4168
Practice Address - Country:US
Practice Address - Phone:425-304-6165
Practice Address - Fax:425-304-6162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7001738Medicaid
WA7112279OtherDSHS GENETIC COUNSELORS
WA7124902Medicaid
WAGAB29427Medicare PIN