Provider Demographics
NPI:1801131628
Name:UNIVERSITY OF WASHINGTON
Entity type:Organization
Organization Name:UNIVERSITY OF WASHINGTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ALVORD PROF. & CHAIR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MONTINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:206-543-1140
Mailing Address - Street 1:1959 NE PACIFIC ST
Mailing Address - Street 2:BOX 356100
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-6100
Mailing Address - Country:US
Mailing Address - Phone:206-598-6400
Mailing Address - Fax:206-598-5068
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:BOX 356100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-6100
Practice Address - Country:US
Practice Address - Phone:206-598-6400
Practice Address - Fax:206-598-5068
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF WASHINGTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3348802Medicaid
500008Medicare Oscar/Certification