Healthcare Provider Details

I. General information

NPI: 1285706036
Provider Name (Legal Business Name): KING COUNTY PUBLIC HOSPITAL DISTRICT NO. 2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12040 NE 128TH ST
KIRKLAND WA
98034-3013
US

IV. Provider business mailing address

PO BOX 34738
SEATTLE WA
98124-1738
US

V. Phone/Fax

Practice location:
  • Phone: 425-899-1000
  • Fax:
Mailing address:
  • Phone: 425-899-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: TINA CHRISTINE MYCROFT
Title or Position: CFO
Credential:
Phone: 425-899-2606