Provider Demographics
NPI:1609906825
Name:KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
Entity Type:Organization
Organization Name:KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
Other - Org Name:GROUP HEALTH EASTSIDE HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-630-1818
Mailing Address - Street 1:PO BOX 34584
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1584
Mailing Address - Country:US
Mailing Address - Phone:509-241-7349
Mailing Address - Fax:509-241-7628
Practice Address - Street 1:2700 152ND AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5543
Practice Address - Country:US
Practice Address - Phone:425-883-5151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GROUP HEALTH COOPERATIVE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-06
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH169276400000X, 282N00000X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003261700Medicaid
WA8020794Medicaid
WADB7688Medicare PIN
WADB8554Medicare PIN
WACG4666Medicare PIN
WACR0091Medicare PIN
WA500052Medicare PIN
WADB6411Medicare PIN
WAG000135000Medicare PIN
WADB1637Medicare PIN
WADC0146Medicare PIN
WADB6523Medicare PIN
WADB8553Medicare PIN
WADC0317Medicare PIN
WADB6754Medicare PIN
WADB8552Medicare PIN
WADC1330Medicare PIN
WA8020794Medicaid
WACK3568Medicare PIN
WADB6409Medicare PIN
WADC1326Medicare PIN
WADK4114Medicare PIN