Provider Demographics
NPI:1992871735
Name:PROVIDENCE EVERETT MEDICAL CENTER
Entity type:Organization
Organization Name:PROVIDENCE EVERETT MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIR REVENUE CYCLE MGMT NWSA
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOBAYASHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-317-0186
Mailing Address - Street 1:909 N BROADWAY
Mailing Address - Street 2:PBO CREDENTIALING
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-1409
Mailing Address - Country:US
Mailing Address - Phone:425-317-0699
Mailing Address - Fax:425-317-0291
Practice Address - Street 1:1001 N BROADWAY
Practice Address - Street 2:SUITE A-3
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1586
Practice Address - Country:US
Practice Address - Phone:425-317-0300
Practice Address - Fax:425-317-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA103TC0700X, 207Q00000X, 207R00000X, 207X00000X, 261QC1500X, 261QF0050X, 363A00000X, 363LF0000X, 363LP0808X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-SurgicalGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7901341OtherFAMILY PLANNING
WA9650268OtherMEDICAID MENTAL HEALTH
WA7136880OtherMEDICAID CLINICAL PSYCHOL
WA7119365OtherMEDICAID FAMILY PRACTICE
WAGAB39976OtherMEDICARE GROUP NUMBER