Southlake Clinic Inc Ps
LBN: Southlake Clinic Inc Ps
Southlake Clinic Inc Ps is an health care organization with primary practice located at 4011 Talbot Road South Suite 500, Renton WA 98055. The organization recently has 2 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Ambulatory Surgical, Ambulatory Health Care Facilities / Endoscopy. Ambulatory Health Care Facilities / Ambulatory Surgical is the primary health care specialty.
Southlake Clinic Inc Ps can be contacted via phone (425) 251-5110, or through Larson, Marianne via phone (425) 251-5110.
Contact Information
Primary practice address
4011 Talbot Road South Suite 500
Renton WA 98055
Phone: (425) 251-5110
Fax: (425) 793-4710
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Ambulatory Health Care Facilities / Ambulatory Surgical | 261QA1903X | FS.60293976 | Washington |
| Ambulatory Health Care Facilities / Endoscopy | 261QE0800X | FS.60293976 | Washington |
Profile Details
| NPI number | 1043368426 |
|---|---|
| LBN Legal business name | Southlake Clinic Inc Ps |
| DBA Doing business as | |
| Authorized official | Larson, Marianne |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Jan 8th, 2007 |
| Last updated | Nov 20th, 2012 - about 12 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1043368426 | NPPES |
| Washington | Other | 490003337 | RAILROAD MEDICARE |
| Washington | Other | 0119463 | RAILROAD MEDICARE |
| Washington | MEDICAID | 7083660 | RAILROAD MEDICARE |
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