SOUTHLAKE CLINIC INC PS (NPI# 1043368426) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043368426 |
| Entity Type | Organization |
| Organization Name | SOUTHLAKE CLINIC INC PS |
| Practice Address |
4011 Talbot Road South Suite 500 Renton WA 98055 |
| Mailing Address |
Po Box 59028 Renton WA 98058-2028 |
| Practice Telephone | 4252515110 |
| Practice Fax Number | 4257934710 |
| Mailing Telephone | 4252515110 |
| Mailing Fax Number | 4257937458 |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2012-11-20 |
| Authorized Official Name | MARIANNE LARSON (DIRECTOR OF OPERATIONS) |
| Authorized Official Telephone | 4252515110 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QE0800X |
Clinic/Center Specialization: Endoscopy |
FS.60293976 | WA | Ambulatory Health Care Facilities |
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
FS.60293976 | WA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | L&I | 0119463 | 01 |
| WA | RAILROAD MEDICARE | 490003337 | 01 |
| WA | 7083660 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548319171 | Southlake Clinic Inc Ps | Clinical Medical Laboratory | 3915 Talbot Road South, Suite 300, Renton, WA 98055 | 2007-01-10 |
| 1538394234 | Southlake Clinic Inc Ps | Pathology | 4011 Talbot Rd S, Suite 500, Renton, WA 98055-5773 | 2009-05-26 |
| 1386800753 | Southlake Clinic Inc Ps | Durable Medical Equipment & Medical Supplies | 3915 Talbot Rd S, Suite 300, Renton, WA 98055-5738 | 2008-08-05 |
| Street Address |
4011 TALBOT ROAD SOUTH SUITE 500 |
| City | RENTON |
| State | WA |
| Zip Code | 98055 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558332700 | Anna L Lien | Registered Nurse | 4011 Talbot Road South, Suite 500, Renton, WA 98055-5791 | 2006-01-27 |
| 1417032798 | Duane G Carlson | Internal Medicine | 4011 Talbot Road South, Suite 500, Renton, WA 98055 | 2006-10-26 |
| 1962587311 | Michael Martin | Internal Medicine | 4011 Talbot Road South, Suite 500, Renton, WA 98055 | 2006-10-26 |
| 1447335401 | Rajib Choudhury | Internal Medicine | 4011 Talbot Road South, Suite 500, Renton, WA 98055 | 2006-10-26 |
| 1376628354 | Terence A Block | Internal Medicine | 4011 Talbot Road South, Suite 500, Renton, WA 98055 | 2006-10-26 |
| 1326122268 | George L Dolack | Internal Medicine | 4011 Talbot Road South, Suite 500, Renton, WA 98055 | 2006-10-25 |
| 1275618720 | John W Nemanich | Internal Medicine | 4011 Talbot Road South, Suite 500, Renton, WA 98055 | 2006-10-25 |
| 1245312420 | Christopher A Dire | Internal Medicine | 4011 Talbot Road South, Suite 500, Renton, WA 98055 | 2006-10-19 |
| 1750463758 | William A Pearce | Internal Medicine | 4011 Talbot Road South, Suite 500, Renton, WA 98055 | 2006-10-19 |
| 1952483943 | Frank J Thomas Jr. | Internal Medicine | 4011 Talbot Road South, Suite 500, Renton, WA 98055 | 2006-10-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356965750 | Proliance Surgery Center At Valley, LLC | Clinic/Center | 4009 Talbot Road S, Suite 200, Renton, WA 98055 | 2020-06-01 |
| 1851804959 | Talbot Rehabilitation Center, LLC | Skilled Nursing Facility | 4430 Talbot Road South, Renton, WA 98055 | 2017-11-10 |
| 1154878668 | Nelson Family Dentistry | Dentist | 19221 108th Ave Se Suite #2, Renton, WA 98055 | 2016-09-01 |
| 1598182990 | Annie Kyunga Ahn | Otolaryngology | 4033 Talbot Rd S Ste 540, Renton, WA 98055 | 2014-03-24 |
| 1376960138 | Madhuri Gordhan Patel | Registered Nurse | 3501 Mill Place South, Renton, WA 98055 | 2014-03-18 |
| 1912331042 | Karen Dohr | Pharmacist | 400 S. 43 Street, Renton, WA 98055 | 2013-08-26 |
| 1659637668 | Benjamin Reiss | Ophthalmology | 4300 Talbot Rd S Ste 300, Renton, WA 98055 | 2012-04-03 |
| 1205137940 | Duy Ai Quang Hoang | Pharmacist | 9431 S 196th Pl, Renton, WA 98055 | 2010-11-11 |
| 1972823664 | Erica L Ellzey | Physical Therapist | 18623 112th Ave Se, Renton, WA 98055 | 2010-06-04 |
| 1588984587 | Melissa A. Jordan | Nurse Anesthetist, Certified Registered | 4011 Talbot Rd., 5th Floor, Renton, WA 98055 | 2010-06-02 |
| Find all providers in zip 98055 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356965750 | Proliance Surgery Center At Valley, LLC | Clinic/Center | 4009 Talbot Road S, Suite 200, Renton, WA 98055 | 2020-06-01 |
| 1205903515 | Ankle & Foot Clinic of Rento | Clinic/Center | 275 Sw 41st St, Renton, WA 98057-4930 | 2006-11-29 |
| 1881845907 | North Pacific Dermatology Ps | Clinic/Center | 1412 Sw 43rd St, Ste 205, Renton, WA 98057-4803 | 2008-10-07 |
| 1922259555 | N W Eye Surgeons, P C | Clinic/Center | 1412 Sw 43rd St, Suite 320, Renton, WA 98057-4803 | 2008-10-01 |
| 1316109309 | Proliance Surgeons Inc Ps | Clinic/Center | 17930 Talbot Rd S, Renton, WA 98055-6230 | 2008-06-30 |
| 1225230634 | Valley Eye and Laser Center, Inc.,p.s. | Clinic/Center | 4011 Talbot Rd S, #210, Renton, WA 98055-5773 | 2007-06-05 |
| 1750321006 | Proliance Surgeons, Inc., P.s. | Clinic/Center | 4033 Talbot Rd S, Suite 270, Renton, WA 98055-5772 | 2006-06-07 |
| 1033117270 | Smc Day Surgery | Clinic/Center | 17910 Talbot Rd S, Suite 100, Renton, WA 98055-6237 | 2005-07-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942808571 | N W Eye Surgeons P C | Clinic/Center | 903 Medical Center Dr Ste 200, Arlington, WA 98223-2600 | 2020-10-15 |
| 1861041139 | Kadlec Regional Medical Center | Clinic/Center | 1270 Lee Blvd Ste B, Richland, WA 99352-4231 | 2019-09-09 |
| 1891357406 | Phoenix Ionm, LLC. | Clinic/Center | 11 Ohrazda Ln, East Wenatchee, WA 98802-9335 | 2019-07-03 |
| 1023570488 | Sight Partners, LLC | Clinic/Center | 3405 188th St Sw Ste 303, Lynnwood, WA 98037-4744 | 2019-04-04 |
| 1609345727 | Liberty Asc | Clinic/Center | 507 N Sullivan Suite 120, Spokane Valley, WA 99037 | 2018-11-19 |
| 1376026575 | Alderwood Surgery Center LLC | Clinic/Center | 3500 188th St Sw Ste 670, Lynnwood, WA 98037-4782 | 2018-09-13 |
| 1023507183 | South Perry Endoscopy Pllc | Clinic/Center | 907 S Perry St Ste 260, Spokane, WA 99202-3462 | 2018-05-04 |
| 1730687179 | Multicare Health System | Clinic/Center | 842 S Cowley St Ste 3, Spokane, WA 99202-1234 | 2018-01-31 |
| 1295258697 | Washington Center for Pain Management Pllc | Clinic/Center | 155 Lilly Rd Ne Ste 2, Olympia, WA 98506-5028 | 2017-07-18 |
| 1871033878 | Redmond Ambulatory Surgery Center, LLC | Clinic/Center | 18100 Ne Union Hill Rd Ste 340, Redmond, WA 98052 | 2017-02-24 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.