Healthcare Provider Details

I. General information

NPI: 1508188566
Provider Name (Legal Business Name): PUBLIC HOSPITAL DISTRICT #1 OF KING COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2010
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 N 10TH ST STE A
RENTON WA
98057-5577
US

IV. Provider business mailing address

PO BOX 34876
SEATTLE WA
98124-1876
US

V. Phone/Fax

Practice location:
  • Phone: 425-656-4211
  • Fax: 425-656-4053
Mailing address:
  • Phone: 425-656-4211
  • Fax: 425-656-4053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberH-155
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberH-155
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberH-155
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH-155
License Number StateWA

VIII. Authorized Official

Name: LARRY SMITH
Title or Position: SR VICE PRESIDENT/CFO
Credential:
Phone: 425-656-5536