Provider Type Icon

OVER LAKE MEDICAL CENTER NPI 1770971830


NPI Information

NPI: 1770971830
Provider Name: OVER LAKE MEDICAL CENTER
Classification: Clinic/Center - 261QM2500X
Entity Type: Organization

Specialization: Medical Specialty

Address:
1750 112TH AVE NE
SUITE A101
BELLEVUE, WA
ZIP 98004
Phone: (425) 688-5234
Get Directions

OVER LAKE MEDICAL CENTER is a medical specialty clinic center in Bellevue, WA. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). OVER LAKE MEDICAL CENTER NPI is 1770971830. The provider is registered as an organization entity type.

The provider's business location address is:

1750 112TH AVE NE
SUITE A101
BELLEVUE, WA
ZIP 98004-752
Phone: (425) 688-5234

The provider's authorized official is Kier Jordan-keith .
The authorized official title is Practice Supervisor and has the following contact phone number (425) 688-5846.

The enumeration date for this NPI number is 12/24/2014 and was last updated on 12/24/2014.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QM2500XClinic/CenterMedical SpecialtyAP60481748WASHINGTONYes

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: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.