Provider Demographics
NPI:1124264577
Name:KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
Entity type:Organization
Organization Name:KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-241-7343
Mailing Address - Street 1:PO BOX 34584
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1584
Mailing Address - Country:US
Mailing Address - Phone:509-241-7349
Mailing Address - Fax:509-241-7628
Practice Address - Street 1:2715 NACHES AVE SW # GSWA1N02
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2627
Practice Address - Country:US
Practice Address - Phone:509-241-7349
Practice Address - Fax:509-241-7628
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB32527Medicare PIN
WAG001247800Medicare PIN
WAGAB32527Medicare PIN
WAG001046100Medicare PIN
WAG001050800Medicare PIN