PUBLIC HOSPITAL DISTRICT #1 OF KING COUNTY (NPI# 1649227380) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649227380 |
| Entity Type | Organization |
| Organization Name | PUBLIC HOSPITAL DISTRICT #1 OF KING COUNTY |
| Other Organization Name | VMC FAIRWOOD PRIMARY CARE |
| Practice Address |
14410 Se Petrovitsky Rd Suite 104 Renton WA 98058-8900 |
| Mailing Address |
3600 Lind Ave Sw Suite 100 Renton WA 98055-4934 |
| Practice Telephone | 4256564242 |
| Mailing Telephone | 4256565412 |
| Mailing Fax Number | 4256565423 |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2008-01-15 |
| Authorized Official Name | MELISSA FARLEY (TECHNICAL COORDINATOR) |
| Authorized Official Telephone | 4259176282 |
| Authorized Official Credential | CPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207QA0505X |
Family Medicine Specialization: Adult Medicine |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 7095839 | 05 |
| Other Name | Type Code |
|---|---|
| VMC Fairwood Primary Care | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528015229 | Public Hospital District #1 of King County | Family Medicine | 3600 Lind Ave Sw, Suite 170, Renton, WA 98055-4934 | 2006-05-28 |
| 1700833480 | Public Hospital District #1 of King County | Physician Assistant | 27230 216th Ave Se, Ste D, Maple Valley, WA 98038-0000 | 2006-05-28 |
| 1629025333 | Public Hospital District #1 of King County | Pediatrics | 6920 Coal Creek Pkwy Se, Ste 12, Newcastle, WA 98059-3147 | 2006-05-28 |
| 1508188566 | Public Hospital District #1 of King County | Internal Medicine | 1205 N 10th St, Ste A, Renton, WA 98057-5577 | 2010-02-18 |
| 1316273345 | Public Hospital District #1 of King County | Counselor | 400 S 43rd St, Renton, WA 98055-5714 | 2009-10-27 |
| 1427384411 | Public Hospital District #1 of King County | Clinical Neuropsychologist | 3915 Talbot Rd S, Ste 104, Renton, WA 98055-5738 | 2009-10-26 |
| 1871748111 | Public Hospital District #1 of King County | Hospitalist | 400 S 43rd St, Renton, WA 98055-5714 | 2008-12-01 |
| 1629245865 | Public Hospital District #1 of King County | Family Medicine | 10555 Se Carr Rd, Ste M, Renton, WA 98055-5820 | 2008-05-15 |
| 1447305693 | Public Hospital District #1 of King County | Neurological Surgery | 1550 N 115th St, Seattle, WA 98133-8401 | 2007-01-25 |
| 1710032917 | Public Hospital District #1 of King County | Neurological Surgery | 3915 Talbot Rd S, Ste 206, Renton, WA 98055-5738 | 2007-01-25 |
| Street Address |
14410 SE PETROVITSKY RD SUITE 104 |
| City | RENTON |
| State | WA |
| Zip Code | 98058-8900 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871995191 | Irene Chege | Physician Assistant | 14410 Se Petrovitsky Rd, Ste 104, Renton, WA 98058-8900 | 2014-09-17 |
| 1730521329 | Joan M Amistoso | Nurse Practitioner | 14410 Se Petrovitsky Rd, Ste 104, Renton, WA 98058-8900 | 2013-07-23 |
| 1649617382 | Devin P Schock | Family Medicine | 14410 Se Petrovitsky Rd, Ste 104, Renton, WA 98058-8900 | 2013-06-03 |
| 1902151491 | Anit Merry Mathew | Dentist | 14410 Se Petrovitsky Rd, #113, Renton, WA 98058 | 2012-07-20 |
| 1376826677 | Ruthe Lillian Graham | Physical Therapist | 14410 Se Petrovitsky Rd, Ste. 202, Renton, WA 98058-8900 | 2011-09-22 |
| 1639307309 | Dawn Renee Kuzaro | Massage Therapist | 14410 Se Petrovitsky Rd, Suite109, Renton, WA 98058-8900 | 2009-07-01 |
| 1831330141 | Brittney S.l. Christopher | Massage Therapist | 14410 Se Petrovitsky Rd, Suite 202, Renton, WA 98058-8900 | 2009-03-16 |
| 1063677375 | Katrina Alene Mccallon | Massage Therapist | 14410 Se Petrovitsky Rd, Suite 209, Renton, WA 98058-8900 | 2008-07-25 |
| 1558586487 | Fairwood Chiropractic Clinic | Chiropractor | 14410 Se Petrovitsky Rd, Ste 109, Renton, WA 98058-8900 | 2007-04-16 |
| 1457428526 | Kim A Schuyler White | Physical Therapist | 14410 Se Petrovitsky Rd, Ste 202, Renton, WA 98058-8900 | 2006-11-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639799471 | Fairwood Dental LLC | Dentist | 14250 Se 176th #j7, Renton, WA 98058 | 2020-04-22 |
| 1538641386 | Kenneth Graber | Physical Therapist | 17650 140th Avenue Sw, Suite B-07, Renton, WA 98058 | 2018-08-29 |
| 1508210154 | Lucy Johnson | Specialist/Technologist | 11808 Se 172nd Ln Apt N303, Renton, WA 98058 | 2016-04-20 |
| 1104253947 | Bertila Martinez | Dental Hygienist | 14600 Se 176th St #v4, Renton, WA 98058 | 2013-10-10 |
| 1326340456 | Tabatha Burris | Specialist | 14410 Petrovistsky Rd Se #109, Renton, WA 98058 | 2010-11-22 |
| 1295042570 | Hanh Q Nguyen | Pharmacist | 16940 116th Avenue Southeast, Renton, WA 98058 | 2010-09-08 |
| 1861692675 | Ernestine Johanna Rombouts | Counselor | 16205 128th Place Se, Renton, WA 98058 | 2007-07-19 |
| 1912100991 | Cara Rozell | Pharmacist | 400 South 43rd St, Renton, WA 98058 | 2007-06-07 |
| 1699821231 | Lynne Suzanne Balderson | Massage Therapist | 14410 Se Petrovitsky Rd #201, Renton, WA 98058 | 2007-01-26 |
| 1023173465 | Sara Jean Denherder | Massage Therapist | 17070 - 140th Ave Se, Renton, WA 98058 | 2006-12-26 |
| Find all providers in zip 98058 | ||||
| Taxonomy Code | 207QA0505X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Adult Medicine |
| Definition to come. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164450748 | Grace B. Gamponia | Family Medicine | 4033 Talbot Rd S, Suite 570, Renton, WA 98055-5772 | 2006-06-30 |
| 1033147756 | John L. Bondi | Family Medicine | 3915 Talbot Rd S, Ste 401, Renton, WA 98055-5738 | 2006-06-29 |
| 1700814589 | Mary E. Butcher | Family Medicine | 451 Duvall Ave Ne, Ste 100, Renton, WA 98059-4675 | 2006-06-29 |
| 1730135088 | Public Hospital District #1 of King County | Family Medicine | 4033 Talbot Rd S, Suite 570, Renton, WA 98055-5772 | 2006-05-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518599273 | Etherton, Inc | Family Medicine | 2610 Yelm Hwy Se, Olympia, WA 98501-4826 | 2020-02-10 |
| 1205494291 | Reah Ann Tobola | Family Medicine | 4602 78th Avenue Ct W, University Place, WA 98466-3036 | 2019-06-04 |
| 1760909055 | Washington State University | Family Medicine | 1455 Ne Cougar Way Bohler Complex, Pullman, WA 99164-0001 | 2017-08-28 |
| 1275057655 | Choice Family Medicine LLC | Family Medicine | 135 Thorne St, Walla Walla, WA 99362-3142 | 2017-07-27 |
| 1366826240 | Andrew Parker | Family Medicine | 3324 Bernie Rd, Camano Island, WA 98282-8217 | 2015-07-10 |
| 1538572151 | Daniel Joseph Cevetello | Family Medicine | 127 Ne Camano Dr Ste A, Camano Island, WA 98282-8732 | 2014-06-11 |
| 1417205618 | John Gary Meyer | Family Medicine | 5715 48th St W, University Place, WA 98467-3677 | 2012-08-17 |
| 1932347119 | Iris Crawford | Family Medicine | 4208 Leary Way, Seattle, WA 98107 | 2009-01-27 |
| 1497925226 | Ingeborg Espinosa Cox | Family Medicine | 325 9th Ave # 359739, Seattle, WA 98104-2420 | 2008-03-07 |
| 1174791974 | Kenneth J Ritter Md Pllc | Family Medicine | 1310 South Union, A-201, Tacoma, WA 98405 | 2008-02-14 |
| Find all providers with the same taxonomy | ||||
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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.