Provider Demographics
NPI:1174527683
Name:VIRGINIA MASON MEDICAL CENTER
Entity type:Organization
Organization Name:VIRGINIA MASON MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:HUNG
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:206-341-0550
Mailing Address - Street 1:1100 NINTH AVE MS: C1-PO
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101
Mailing Address - Country:US
Mailing Address - Phone:206-223-6877
Mailing Address - Fax:206-223-7606
Practice Address - Street 1:1100 NINTH AVE MS: C1-PO
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101
Practice Address - Country:US
Practice Address - Phone:206-223-6877
Practice Address - Fax:206-223-7606
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIRGINIA MASON MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-13
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA262010301062333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6082101Medicaid
WA4913782OtherNCPDP