Healthcare Provider Details

I. General information

NPI: 1528015229
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: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 LIND AVE SW SUITE 170
RENTON WA
98055-4934
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 425-656-4260
  • Fax:
Mailing address:
  • Phone: 425-656-5412
  • Fax: 425-656-5423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

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