Provider Demographics
NPI:1619580891
Name:ALTIUS INSTITUTE FOR BIOMEDICAL SCIENCES
Entity Type:Organization
Organization Name:ALTIUS INSTITUTE FOR BIOMEDICAL SCIENCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH-JENNESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-267-1091
Mailing Address - Street 1:2211 ELLIOTT AVE STE 410
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-3591
Mailing Address - Country:US
Mailing Address - Phone:206-267-1091
Mailing Address - Fax:
Practice Address - Street 1:2211 ELLIOTT AVE STE 103
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-3622
Practice Address - Country:US
Practice Address - Phone:206-267-1091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA50D2181782OtherCLIA