Provider Demographics
NPI:1770899189
Name:SWEDISH EDMONDS
Entity type:Organization
Organization Name:SWEDISH EDMONDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SECREATRY FOR ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:425-358-9786
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:425-673-3374
Mailing Address - Fax:425-640-4455
Practice Address - Street 1:21600 HIGHWAY 99 STE 150
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8047
Practice Address - Country:US
Practice Address - Phone:425-673-3380
Practice Address - Fax:425-673-3382
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SWEDISH EDMONDS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-23
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G8895545Medicare PIN