Provider Demographics
NPI:1255447595
Name:HIGHLINE MEDICAL CENTER
Entity type:Organization
Organization Name:HIGHLINE MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MPA
Authorized Official - Phone:206-439-9095
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
Mailing Address - Country:US
Mailing Address - Phone:206-439-9095
Mailing Address - Fax:206-433-1031
Practice Address - Street 1:2801 S 128TH SUITE A
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168
Practice Address - Country:US
Practice Address - Phone:206-439-9095
Practice Address - Fax:206-433-1031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA15318OtherLICENSE
WA3990280Medicaid
501527Medicare ID - Type Unspecified