Provider Demographics
NPI:1194820001
Name:WASHINGTON STATE DEPARTMENT OF HEALTH
Entity type:Organization
Organization Name:WASHINGTON STATE DEPARTMENT OF HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASST SECRETARY, FINANCIAL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-236-4503
Mailing Address - Street 1:PO BOX 47901
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98504-7901
Mailing Address - Country:US
Mailing Address - Phone:360-236-4503
Mailing Address - Fax:360-236-4500
Practice Address - Street 1:1610 NE 150TH ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-7224
Practice Address - Country:US
Practice Address - Phone:206-418-5410
Practice Address - Fax:206-418-5415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9011883Medicaid