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General NPI Number Information
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NPI Number | 1285709915
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Entity Type | Organization
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Legal Business Name | EMERALD CITY INTERNAL MEDICINE PLLC
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 02/23/2009
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Provider Practice Location Address
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Address Line | 14517 60TH AVE W
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City | EDMONDS
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State | WA
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Zip | 98026-3605
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Country | US
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Telephone | 206-386-3500
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Fax | 206-386-3568
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Provider Business Mailing Address
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Address Line | 14517 60TH AVE W
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City | EDMONDS
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State | WA
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Zip | 98026-3605
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Country | US
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Telephone | 206-386-3500
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Fax | 206-386-3568
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS J SMITH
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Credential | MD
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Telephone | 206-386-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD000116322
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License Number State | WA
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