Active NPI
PHD#2 of Snohomish County
- Psychiatric Hospital Unit
- Edmonds, WA
National Provider Identifier
1023006061
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric Hospital Unit
- License
- H-138
- Legal business name
- PHD#2 OF SNOHOMISH COUNTY
- Doing business as
- Stevens Hospital, Stevens Memorial Hospital
- Practice address
- 21601 76TH Ave W
Edmonds, WA 98026-7507 - Phone
- (425) 640-4000
- Fax
- (425) 640-4432
- NPI assigned
- Oct 13, 2005
- Organization subpart
- Yes
- Parent organization
- PHD#2 OF SNOHOMISH COUNTY
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Gary Wangsmo
- Title
- Cfo
- Phone
- (425) 640-4113
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric Hospital Unit | 273R00000X | H-138 | WA | Primary |
Addresses
Primary practice location
21601 76TH Ave W
Edmonds, WA 98026-7507
Mailing address
21601 76TH Ave W
Edmonds, WA 98026-7507
Phone (425) 640-4000
Other identifiers 10
| Identifier | Type | State | Issuer |
|---|---|---|---|
| W718582 | Other | WA | CHAMPUS |
| MC150 | Other | WA | PREMERA BLUE CROSS |
| ST0092 | Other | WA | REGENCE BLUE SHIELD |
| 150 | Other | WA | PREMERA BLUE CROSS |
| 11031 | Other | WA | WA DEPT OF L&I |
| 0288 | Other | WA | REGENCE BLUE SHIELD |
| 3500071 | Medicaid | WA | |
| HP150 | Other | WA | PREMERA BLUE CROSS |
| 0065668 | Other | WA | AETNA |
| 6580520 | Other | WA | AETNA |
Other names 1
- Stevens Hospital, Stevens Memorial Hospital
National Provider Directory
National Provider Directory- Tax ID family
- Stevens Prime Care
- Part of
- Stevens Prime Care
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Institutional Pharmacy
- Edmonds, WA
- NPI 1275718348
-
- Cardiovascular Disease Physician
- Edmonds, WA
- NPI 1134319056
Ownership & related parties
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
- Institutional Pharmacy
- Edmonds, WA
- NPI 1275718348
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129161600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1188259200000",
"number": "1023006061",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21601 76TH AVE W",
"city": "EDMONDS",
"state": "WA",
"postal_code": "980267507",
"telephone_number": "425-640-4000",
"fax_number": "425-640-4432"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21601 76TH AVE W",
"city": "EDMONDS",
"state": "WA",
"postal_code": "980267507",
"telephone_number": "425-640-4000",
"fax_number": "425-640-4432"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PHD#2 OF SNOHOMISH COUNTY",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "PHD#2 OF SNOHOMISH COUNTY",
"enumeration_date": "2005-10-13",
"last_updated": "2007-08-28",
"status": "A",
"authorized_official_last_name": "WANGSMO",
"authorized_official_first_name": "GARY",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "425-640-4113",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "273R00000X",
"taxonomy_group": "",
"desc": "Psychiatric Unit",
"state": "WA",
"license": "H-138",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPUS",
"identifier": "W718582",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREMERA BLUE CROSS",
"identifier": "MC150",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD",
"identifier": "ST0092",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREMERA BLUE CROSS",
"identifier": "150",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WA DEPT OF L&I",
"identifier": "11031",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD",
"identifier": "0288",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3500071",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREMERA BLUE CROSS",
"identifier": "HP150",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "0065668",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "6580520",
"state": "WA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Stevens Hospital, Stevens Memorial Hospital",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Edmonds, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.