SOUTHLAKE CLINIC INC PS NPI 1043368426

NPI Information

NPI: 1043368426
Provider Name: SOUTHLAKE CLINIC INC PS
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

Address:
4011 TALBOT ROAD SOUTH
SUITE 500
RENTON, WA
ZIP 98055
Phone: (425) 251-5110
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SOUTHLAKE CLINIC INC PS is an ambulatory surgical clinic center in Renton, WA. SOUTHLAKE CLINIC INC PS NPI is 1043368426. The provider is registered as an organization entity type.

The provider's business location address is:

4011 TALBOT ROAD SOUTH
SUITE 500
RENTON, WA
ZIP 98055
Phone: (425) 251-5110
Fax: (425) 793-4710

The provider's authorized official is Marianne Larson .
The authorized official title is Director Of Operations and has the following contact phone number (425) 251-5110.

The enumeration date for this NPI number is 1/8/2007 and was last updated on 11/20/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QE0800X	Clinic/Center	Endoscopy	FS.60293976	WASHINGTON	No
2	261QA1903X	Clinic/Center	Ambulatory Surgical	FS.60293976	WASHINGTON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	7083660	MEDICAID	WASHINGTON
2	490003337	OTHER	WASHINGTON	RAILROAD MEDICARE
3	0119463	OTHER	WASHINGTON	L&I
4	217000856	MEDICARE PIN	WASHINGTON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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