Basic Information
| Provider Information | |||||||||
| NPI: | 1033107214 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SWEDISH EDMONDS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PUBLIC HOSPITAL DISTRICT 2 OF SNOHOMISH COUNTY | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 271627 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841271627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256404000 | ||||||||
| FaxNumber: | 4256404432 | ||||||||
| Practice Location | |||||||||
| Address1: | 21601 76TH AVE W | ||||||||
| Address2: | |||||||||
| City: | EDMONDS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980267507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256404000 | ||||||||
| FaxNumber: | 4256404432 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2005 | ||||||||
| LastUpdateDate: | 04/10/2019 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ANDERSON | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
| AuthorizedOfficialMiddleName: | WAYNE | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR REIMBURSEMENT ADMIN | ||||||||
| AuthorizedOfficialTelephone: | 4255255392 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | HAC.FS.60183546 | WA | N | Hospital Units | Psychiatric Unit | 282N00000X | HAC.FS.60183546 | WA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 191514500 | 01 | WA | WORKERS COMP FEDERAL | OTHER | 6580520 | 01 | WA | AETNA | OTHER | MC150 | 01 | WA | PREMERA BLUE CROSS | OTHER | 0065668 | 01 | WA | AETNA | OTHER | W718582 | 01 | WA | CHAMPUS | OTHER | HP150 | 01 | WA | PREMERA BLUE CROSS | OTHER | 267677 | 01 | WA | WA STATE LABOR AND INDUSTRY | OTHER | 0288 | 01 | WA | REGENCE BLUE SHIELD | OTHER | 150 | 01 | WA | PREMERA BLUE CROSS | OTHER | 013722001 | 01 | WA | GROUP HEALTH | OTHER | 3341807 | 05 | WA | MEDICAID | ST0092 | 01 | WA | REGENCE BLUE SHIELD | OTHER |