SOUTHLAKE CLINIC INC PS (NPI# 1548319171) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548319171 |
| Entity Type | Organization |
| Organization Name | SOUTHLAKE CLINIC INC PS |
| Other Organization Name | VALLEY INTERNAL MEDICINE INC PS |
| Practice Address |
3915 Talbot Road South Suite 300 Renton WA 98055 |
| Mailing Address |
Po Box 59028 Renton WA 98058-2028 |
| Practice Telephone | 4252515110 |
| Practice Fax Number | 4252269085 |
| Mailing Telephone | 4252515110 |
| Mailing Fax Number | 4257934707 |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2010-03-03 |
| Authorized Official Name | MARIANNE LARSON (CHIEF OPERATIONS OFFICER) |
| Authorized Official Telephone | 4252515110 |
| Is Organization Subpart | Y |
| Parent Organization Name | SOUTHLAKE CLINIC INC PS |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 291U00000X | Clinical Medical Laboratory | 600052154 | WA | Laboratories |
| Other Name | Type Code |
|---|---|
| Valley Internal Medicine Inc PS | Former Legal Business Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1043368426 | Southlake Clinic Inc Ps | Clinic/Center | 4011 Talbot Road South, Suite 500, Renton, WA 98055 | 2007-01-08 |
| Street Address |
3915 TALBOT ROAD SOUTH SUITE 300 |
| City | RENTON |
| State | WA |
| Zip Code | 98055 |
| 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 | 291U00000X |
| Grouping | Laboratories |
| Classification | Clinical Medical Laboratory |
| (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology. |
| Notes: Source: (1) Code of Federal Regulations #42, Public Health, Section 493.2. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 186. |
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| 1215598727 | New Life Lab Services LLC | Clinical Medical Laboratory | 5019 Grove St Ste 103b, Marysville, WA 98270-4487 | 2019-06-25 |
| 1356906713 | Actx, Inc. | Clinical Medical Laboratory | 2101 4th Ave Ste 1180, Seattle, WA 98121-2318 | 2019-05-01 |
| 1851850218 | Advantage Dx Inc | Clinical Medical Laboratory | 1801 W Broadway Ave, Spokane, WA 99201-1819 | 2019-03-15 |
| 1295294973 | Ubmhc1, LLC | Clinical Medical Laboratory | 18110 Southeast 34th St, Building 2, Suite 240, Vancouver, WA 98683 | 2019-03-13 |
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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.