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Contact Information

SOUTHLAKE CLINIC INC PS
3915 TALBOT ROAD SOUTH
SUITE 300
RENTON, WA98055
 Phone: 425-251-5110
 Fax: 425-226-9085
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical Medical Laboratory

291U00000X 69 Clinical Laboratory
Indicates primary specialty

NPI Profile & details for SOUTHLAKE CLINIC INC PS

NPI # 1548319171
LBN Legal business name SOUTHLAKE CLINIC INC PS
Authorized official MARIANNE LARSON - (CHIEF OPERATIONS OFFICER)
Entity Organization
Organization subpart 1 Yes
Enumeration date 01/10/2007
Last updated 03/03/2010 - About 16 years ago
Identifiers
WA License # 600052154
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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