Healthcare Provider Details

I. General information

NPI: 1609932102
Provider Name (Legal Business Name): PUBLIC HOSPITAL DISTRICT #1 OF KING COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 TALBOT RD S STE 560
RENTON WA
98055-5772
US

IV. Provider business mailing address

3915 TALBOT RD S STE 100
RENTON WA
98055-5738
US

V. Phone/Fax

Practice location:
  • Phone: 425-251-5111
  • Fax: 425-656-5387
Mailing address:
  • Phone: 425-656-5412
  • Fax: 425-656-4079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberH-155
License Number StateWA

VIII. Authorized Official

Name: MICHAEL I BERNSTEIN
Title or Position: CFO
Credential:
Phone: 425-656-5565