Provider Demographics
NPI:1700818705
Name:VASCULAR ACCESS CENTER OF SEATTLE
Entity Type:Organization
Organization Name:VASCULAR ACCESS CENTER OF SEATTLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-382-3680
Mailing Address - Street 1:14220 INTERURBAN AVE S
Mailing Address - Street 2:SUITE A110
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-4662
Mailing Address - Country:US
Mailing Address - Phone:206-439-1710
Mailing Address - Fax:
Practice Address - Street 1:14220 INTERURBAN AVE S
Practice Address - Street 2:SUITE A110
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-4662
Practice Address - Country:US
Practice Address - Phone:206-439-1710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7136054Medicaid
WA=========OtherREGENCE BLUE SHIELD
WA=========OtherREGENCE BLUE SHIELD