=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013014786
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PUBLIC HOSPITAL DISTRICT NO 2
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2006
-----------------------------------------------------
Last Update Date | 01/04/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8301 161ST AVE NE SUITE 105
-----------------------------------------------------
City | REDMOND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98052-3858
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-883-3333
-----------------------------------------------------
Fax | 425-869-4854
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 34036
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98124-1036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-899-3292
-----------------------------------------------------
Fax | 425-899-3269
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. ROBERT MALTE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 425-899-2610
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------