Healthcare Provider Details

I. General information

NPI: 1982757522
Provider Name (Legal Business Name): PUBLIC HOSPITAL DISTRICT #1 OF KING COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 TALBOT RD S STE 104
RENTON WA
98055-5738
US

IV. Provider business mailing address

3600 LIND AVE SW STE 100
RENTON WA
98057-4934
US

V. Phone/Fax

Practice location:
  • Phone: 425-656-5566
  • Fax: 425-656-5567
Mailing address:
  • Phone: 425-656-5412
  • Fax: 425-656-4079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberH-155
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberH-155
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberH-155
License Number StateWA

VIII. Authorized Official

Name: MICHAEL I BERNSTEIN
Title or Position: CFO
Credential:
Phone: 425-656-5303