Provider Demographics
NPI:1558333203
Name:U. S. COAST GUARD HEALTH SERVICES/ISC SEATTLE
Entity type:Organization
Organization Name:U. S. COAST GUARD HEALTH SERVICES/ISC SEATTLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:WADDINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:206-217-6436
Mailing Address - Street 1:10019 48TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-8127
Mailing Address - Country:US
Mailing Address - Phone:206-306-9561
Mailing Address - Fax:206-217-6636
Practice Address - Street 1:1519 ALASKAN WAY S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-1102
Practice Address - Country:US
Practice Address - Phone:206-217-6436
Practice Address - Fax:206-217-6636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004424261QM1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient