Provider Demographics
NPI:1013450386
Name:KING COUNTY PUBLIC HOSPITAL DISTRICT NO 2
Entity Type:Organization
Organization Name:KING COUNTY PUBLIC HOSPITAL DISTRICT NO 2
Other - Org Name:EVERGREENHEALTH LAKESHORE BOTHELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MALTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-899-2610
Mailing Address - Street 1:10025 NE 186TH ST
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3839
Mailing Address - Country:US
Mailing Address - Phone:425-486-9131
Mailing Address - Fax:425-486-9490
Practice Address - Street 1:10131 MAIN ST
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3425
Practice Address - Country:US
Practice Address - Phone:425-485-3955
Practice Address - Fax:425-485-1476
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KING COUNTY PUBLIC HOSPITAL DISTRICT NO 2
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty