Healthcare Provider Details

I. General information

NPI: 1760620132
Provider Name (Legal Business Name): PUBLIC HOSPITAL DISTRICT#1 OF KING COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 01/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10555 SE CARR RD STE M
RENTON WA
98055-5820
US

IV. Provider business mailing address

PO BOX 34876
SEATTLE WA
98124-1876
US

V. Phone/Fax

Practice location:
  • Phone: 425-656-4270
  • Fax: 425-656-4271
Mailing address:
  • Phone: 425-656-5412
  • Fax: 425-656-4096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH-155
License Number StateWA

VIII. Authorized Official

Name: PATRICIA KYLE
Title or Position: BUSINESS DEVELOPMENT
Credential:
Phone: 425-228-3440