Basic Information
| Provider Information | |||||||||
| NPI: | 1043694185 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KING COUNTY PUBLIC HOSPITAL DISTRICT NO. 2 | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | EVERGREENHEALTH AMBULATORY SURGICAL CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12333 NE 130TH LN | ||||||||
| Address2: | #420 | ||||||||
| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980347467 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 12333 NE 130TH LN | ||||||||
| Address2: | #420 | ||||||||
| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980347467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258995500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2015 | ||||||||
| LastUpdateDate: | 11/24/2015 | ||||||||
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| AuthorizedOfficialLastName: | YAMADA | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINE | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4258991000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | KING COUNTY PUBLIC HOSPITAL DISTRICT NO. 2 | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.