Provider Demographics
NPI:1023678240
Name:WASHINGTON INSTITUTE FOR COAGULATION
Entity type:Organization
Organization Name:WASHINGTON INSTITUTE FOR COAGULATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUSE-JARRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-614-1200
Mailing Address - Street 1:701 PIKE ST STE 1900
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-3932
Mailing Address - Country:US
Mailing Address - Phone:206-614-1200
Mailing Address - Fax:206-614-1700
Practice Address - Street 1:701 PIKE ST STE 1900
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-3932
Practice Address - Country:US
Practice Address - Phone:206-614-1200
Practice Address - Fax:206-614-1700
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WA INSTITUTE FOR COAGULATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-19
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1023678240Medicaid