Provider Demographics
NPI:1891883435
Name:KING COUNTY PUBLIC HOSPITAL DISTRICT NO 2
Entity Type:Organization
Organization Name:KING COUNTY PUBLIC HOSPITAL DISTRICT NO 2
Other - Org Name:EVERGREEN HEALTHCARE OB HOSPITALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:MYCROFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-899-2606
Mailing Address - Street 1:PO BOX 34036
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1036
Mailing Address - Country:US
Mailing Address - Phone:425-899-3292
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:2006-10-10
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACJ9678OtherMEDICARE RAILROAD
WACQ2437OtherMEDICARE RAILROAD
WACG8137OtherMEDICARE RAILROAD
WA7127426Medicaid
WACG2833OtherMEDICARE RAILROAD
WACJ9678OtherMEDICARE RAILROAD