Provider Demographics
NPI:1093963795
Name:STACEY L. HILES, M.D., PLLC
Entity Type:Organization
Organization Name:STACEY L. HILES, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PRACTICE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HILES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-235-9614
Mailing Address - Street 1:17900 TALBOT RD S
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-8212
Mailing Address - Country:US
Mailing Address - Phone:425-235-9614
Mailing Address - Fax:425-235-1060
Practice Address - Street 1:17900 TALBOT RD S
Practice Address - Street 2:SUITE 101
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-8212
Practice Address - Country:US
Practice Address - Phone:425-235-9614
Practice Address - Fax:425-235-1060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-05
Last Update Date:2008-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60021347261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1126143Medicaid