Provider Demographics
NPI:1710105010
Name:UNIVERSITY OF WASHINGTON
Entity Type:Organization
Organization Name:UNIVERSITY OF WASHINGTON
Other - Org Name:UNIVERSITY OF WASHINGTON MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER LABMED
Authorized Official - Prefix:
Authorized Official - First Name:MARCELO
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLANTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-616-8886
Mailing Address - Street 1:PO BOX 24366
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0366
Mailing Address - Country:US
Mailing Address - Phone:206-598-0502
Mailing Address - Fax:206-598-0516
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:BOX 357110
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-616-8900
Practice Address - Fax:206-616-8911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH-128291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5561754OtherAETNA
WALABMEDOtherFIRST CHOICE
WA5431552006OtherCIGNA
WA81-0000362OtherPREMERA
WA13OtherUNIFORM MEDICAL PLAN
WALABMEDOtherWPAS
WAUN0216OtherREGENCE
WA34OtherUNITED HEALTH CARE
WA7072168Medicaid