Overlake Colon & Rectal Clinic, Pllc

LBN: Overlake Colon & Rectal Clinic, Pllc
Overlake Colon & Rectal Clinic, Pllc is an health care organization with primary practice located at 1135 116Th Ave Ne Suite 190, Bellevue WA 98004-4623. The organization recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Colon & Rectal Surgery. Allopathic & Osteopathic Physicians / Colon & Rectal Surgery is the primary health care specialty. Overlake Colon & Rectal Clinic, Pllc can be contacted via phone (425) 646-7400, or through Ehsan, Mitra via phone (206) 669-7639.

Contact Information

Primary practice address
1135 116Th Ave Ne Suite 190 Bellevue WA 98004-4623
Phone: (425) 646-7400
Fax: (425) 646-7449
Website:
Map and Directions
Authorized official contact:
Name: Ehsan, Mitra Doctor of Medicine (MD)
Phone: (206) 669-7639

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X MD00039612 Washington
Allopathic & Osteopathic Physicians / Colon & Rectal Surgery 208C00000X MD00039612 Washington

Profile Details

NPI number 1063688273
LBN Legal business name Overlake Colon & Rectal Clinic, Pllc
DBA Doing business as
Authorized official Ehsan, Mitra Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date May 7th, 2008
Last updated Sep 4th, 2019 - about 5 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063688273 NPPES
Washington Other 0159746 L&I
Washington Other 1135EH L&I
Washington Other 2185705 L&I
Washington MEDICAID 1115864 L&I
Washington Other 5810380 L&I

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