NPIMap

Organization Active NPI

King County Public Hospital District No 2

Doing business as EvergreenHealth Lakeshore Bothell

  • Family Medicine Physician
  • Bothell, WA
National Provider Identifier
1013450386
Registry record updated Nov 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
KING COUNTY PUBLIC HOSPITAL DISTRICT NO 2
Doing business as
EvergreenHealth Lakeshore Bothell
Practice address
10131 Main St
Bothell, WA 98011-3425
Phone
(425) 485-3955
Fax
(425) 485-1476
NPI assigned
Nov 18, 2016
Organization subpart
Yes
Parent organization
KING COUNTY PUBLIC HOSPITAL DISTRICT NO 2As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 18, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Robert Malte
Title
Ceo
Phone
(425) 899-2610

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X

Addresses

Primary practice location

10131 Main St
Bothell, WA 98011-3425

Mailing address

10025 NE 186TH St
Bothell, WA 98011-3839
Phone (425) 486-9131

Other names 1

  • EvergreenHealth Lakeshore Bothell Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ehmc Bothell Sr HLTH CT25 organizations share this tax ID, including this one
Part of
Ehmc Bothell Sr HLTH CT

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1479427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479427200000",
    "number": "1013450386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10025 NE 186TH ST",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980113839",
            "telephone_number": "425-486-9131",
            "fax_number": "425-486-9490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10131 MAIN ST",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980113425",
            "telephone_number": "425-485-3955",
            "fax_number": "425-485-1476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KING COUNTY PUBLIC HOSPITAL DISTRICT NO 2",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KING COUNTY PUBLIC HOSPITAL DISTRICT NO 2",
        "enumeration_date": "2016-11-18",
        "last_updated": "2016-11-18",
        "status": "A",
        "authorized_official_last_name": "MALTE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "425-899-2610"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EvergreenHealth Lakeshore Bothell",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bothell, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.