Healthcare Provider Details

I. General information

NPI: 1235453630
Provider Name (Legal Business Name): PUBLIC HOSPITAL DISTRIOCT #1 OF KING COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 TALBOT RD S STE 230
RENTON WA
98055-5772
US

IV. Provider business mailing address

PO BOX 34876
SEATTLE WA
98124-1876
US

V. Phone/Fax

Practice location:
  • Phone: 425-656-4200
  • Fax: 425-656-4258
Mailing address:
  • Phone: 425-656-5412
  • Fax: 425-656-5565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberH-155
License Number StateWA

VIII. Authorized Official

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