Provider Demographics
NPI:1982025128
Name:SEATTLE CANCER CARE ALLIANCE
Entity Type:Organization
Organization Name:SEATTLE CANCER CARE ALLIANCE
Other - Org Name:SCCA AT NW HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP CFO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TINGSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-288-1060
Mailing Address - Street 1:1560 N 115TH ST
Mailing Address - Street 2:SUITE G-16A
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8414
Mailing Address - Country:US
Mailing Address - Phone:206-368-5802
Mailing Address - Fax:
Practice Address - Street 1:1560 N 115TH ST STE G-16A
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8414
Practice Address - Country:US
Practice Address - Phone:206-368-5802
Practice Address - Fax:206-368-1403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-13
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0002X
WAPHAR.CF.604681463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146071OtherPK
WA4352590003Medicare NSC
WA4352590001Medicare NSC
500138OtherMEDICARE ID