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General NPI Number Information
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NPI Number | 1992074066
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Entity Type | Organization
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Legal Business Name | EMERALD CITY SPORTS & SPINE MEDICINE
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Dates
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Enumeration Date | 12/20/2011
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Last Update Date | 02/22/2012
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Provider Practice Location Address
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Address Line | 1632 116TH AVE NE STE C
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City | BELLEVUE
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State | WA
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Zip | 98004-3035
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Country | US
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Telephone | 425-818-0558
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Fax | 888-557-3062
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Provider Business Mailing Address
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Address Line | 6924 SE ALLEN ST
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City | MERCER ISLAND
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State | WA
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Zip | 98040-3357
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Country | US
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Telephone | 206-852-8898
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | GARRETT S HYMAN
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Credential | MD, MPH
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Telephone | 206-852-8898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | MD 39116
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License Number State | WA
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