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General NPI Number Information
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NPI Number | 1740260892
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Entity Type | Organization
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Legal Business Name | LAKE HILLS MEDICAL ASSOC
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Dates
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Enumeration Date | 01/17/2006
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Last Update Date | 01/07/2011
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Provider Practice Location Address
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Address Line | 14858 LAKE HILLS BLVD
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City | BELLEVUE
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State | WA
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Zip | 98007-5821
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Country | US
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Telephone | 208-816-1332
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Fax |
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Provider Business Mailing Address
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Address Line | 1525 BURRELL DR
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City | LEWISTON
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State | ID
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Zip | 83501-5827
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Country | US
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Telephone | 208-816-1332
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | AMY L LARSON
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Credential |
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Telephone | 208-798-8968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD00015580
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License Number State | WA
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