Provider Demographics
NPI:1790852077
Name:HIGHLINE MEDICAL CENTER
Entity Type:Organization
Organization Name:HIGHLINE MEDICAL CENTER
Other - Org Name:HIGHLINE MEDICAL CENTER GERO PSYCH
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:
Authorized Official - Last Name:KAERSTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-431-5320
Mailing Address - Street 1:12844 MILITARY RD S
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-3045
Mailing Address - Country:US
Mailing Address - Phone:206-431-5320
Mailing Address - Fax:
Practice Address - Street 1:12844 MILITARY RD S
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-3045
Practice Address - Country:US
Practice Address - Phone:206-431-5320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH-126273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA50S011Medicare ID - Type UnspecifiedGERO-PSYCH