Provider Demographics
NPI:1235453630
Name:PUBLIC HOSPITAL DISTRIOCT #1 OF KING COUNTY
Entity Type:Organization
Organization Name:PUBLIC HOSPITAL DISTRIOCT #1 OF KING COUNTY
Other - Org Name:VALLEY OTOLARYNGOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VICE PRESIDENT FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-656-5536
Mailing Address - Street 1:PO BOX 34876
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1876
Mailing Address - Country:US
Mailing Address - Phone:425-656-5412
Mailing Address - Fax:425-656-5565
Practice Address - Street 1:4033 TALBOT RD S
Practice Address - Street 2:STE 230
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5772
Practice Address - Country:US
Practice Address - Phone:425-656-4200
Practice Address - Fax:425-656-4258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH-155207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty