Healthcare Provider Details

I. General information

NPI: 1184715476
Provider Name (Legal Business Name): CITY OF BOTHELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 02/09/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10726 BEARDSLEE BLVD
BOTHELL WA
98011-3250
US

IV. Provider business mailing address

PO BOX 3510
SILVERDALE WA
98383-3510
US

V. Phone/Fax

Practice location:
  • Phone: 425-486-1678
  • Fax:
Mailing address:
  • Phone: 360-394-7030
  • Fax: 360-394-7097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number17M04
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier9054255
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name: CATHLEEN LAUREL FARRELL
Title or Position: ADMIN. SERVICES MGR.
Credential:
Phone: 425-806-6242