Provider Demographics
NPI:1508188566
Name:PUBLIC HOSPITAL DISTRICT #1 OF KING COUNTY
Entity Type:Organization
Organization Name:PUBLIC HOSPITAL DISTRICT #1 OF KING COUNTY
Other - Org Name:VMC RENTON LANDING URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VICE PRESIDENT/CFO
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:425-656-4211
Mailing Address - Fax:425-656-4053
Practice Address - Street 1:1205 N 10TH ST
Practice Address - Street 2:STE A
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5577
Practice Address - Country:US
Practice Address - Phone:425-656-4211
Practice Address - Fax:425-656-4053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH-155207Q00000X, 207R00000X, 363A00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty