Provider Demographics
NPI:1033174933
Name:KING COUNTY PUBLIC HOSPITAL DISTRICT NO. 2
Entity Type:Organization
Organization Name:KING COUNTY PUBLIC HOSPITAL DISTRICT NO. 2
Other - Org Name:EVERGREENHEALTH MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CFO
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:HEMEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-899-2606
Mailing Address - Street 1:PO BOX 102928
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91189-2928
Mailing Address - Country:US
Mailing Address - Phone:425-899-3868
Mailing Address - Fax:425-899-3269
Practice Address - Street 1:12040 NE 128TH ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3013
Practice Address - Country:US
Practice Address - Phone:425-899-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KING COUNTY PUBLIC HOSPITAL DISTRICT NO. 2
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-20
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH164282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA500124Medicare Oscar/Certification