Healthcare Provider Details

I. General information

NPI: 1700833480
Provider Name (Legal Business Name): PUBLIC HOSPITAL DISTRICT #1 OF KING COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27230 216TH AVE SE STE D
MAPLE VALLEY WA
98038-0000
US

IV. Provider business mailing address

3600 LIND AVE SW SUITE 100
RENTON WA
98055-4934
US

V. Phone/Fax

Practice location:
  • Phone: 425-656-4100
  • Fax: 425-656-4109
Mailing address:
  • Phone: 425-656-5412
  • Fax: 425-656-5423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA FARLEY
Title or Position: TECHNICAL COORDINATOR
Credential: CPC
Phone: 425-917-6282