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PED503300-08 SEATTLE CHILDREN'S HOSPITAL (Terminated)
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Main Details
Name
SEATTLE CHILDREN'S HOSPITAL
Subdivision Name
Orthotics & Prosthetics at Sand Point Way
Type
Children's Hospital
Rural
No
340B ID
PED503300-08
Medicare Provider Number
503300
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/11/2013
Participating Start Date
7/1/2013
Participating Approval Date
6/10/2013
Last Recertification Date
8/13/2015
Termination Date
Termination Reason
4/1/2016
Site closure
Contacts
Authorizing Official
Seattle Children's Hospital
Warren E Hewitt, VP, Finance and Chief Accounting Officer
(206) 884-2378
Primary Contact
Seattle Children's Hospital
JERRY KINZIG, DIRECTOR OF REIMBURSEMENT
(206) 884-2361
Addresses
Street Address
4575 Sand Point Way NE, Suite 106
Seattle, WA 98105
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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