Provider Demographics
NPI:1649408568
Name:HARBORVIEW MEDICAL CENTER
Entity Type:Organization
Organization Name:HARBORVIEW MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SOMMER
Authorized Official - Middle Name:KLEWENO
Authorized Official - Last Name:WALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-744-3000
Mailing Address - Street 1:PO BOX 34001
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1001
Mailing Address - Country:US
Mailing Address - Phone:206-598-1950
Mailing Address - Fax:206-598-0961
Practice Address - Street 1:501 EASTLAKE AVE E
Practice Address - Street 2:SUITE 300
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-5546
Practice Address - Country:US
Practice Address - Phone:206-598-4026
Practice Address - Fax:206-598-4761
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARBORVIEW MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-30
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH-029332B00000X, 332S00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0013894OtherL&I GROUP PIN
WA9054602Medicaid
WA9048018Medicaid
WA9054222Medicaid
WA9054602Medicaid