Provider Demographics
NPI:1467542639
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 GROUP PRO FEES
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:MS 105
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3013
Practice Address - Country:US
Practice Address - Phone:425-899-2560
Practice Address - Fax:425-899-2079
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KING COUNTY PUBLIC HOSPITAL DISTRICT NO 2
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-16
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACG2833OtherMEDICARE RAILROAD
WACQ2437OtherMEDICARE RAILROAD
WA7141351Medicaid
WACG8137OtherMEDICARE RAILROAD
WACJ9678OtherMEDICARE RAILROAD
WA7099559Medicaid
WAGAB13314Medicare PIN