Southlake Clinic Inc PS

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

SOUTHLAKE CLINIC INC PS

Practice address

3915 Talbot Rd S
Suite 300
Renton, WA 98055-5738

Phone

(425) 251-5110

Fax

(425) 793-7458

NPI assigned

Aug 5, 2008

Organization subpart

Yes

Parent organization

SOUTHLAKE CLINIC INC PSAs reported in NPPES

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

Authorized official

Name

Mrs. Marianne Larson

Title

Chief Operating Officer

Phone

(425) 251-5110

Specialties & licenses 1

Addresses

Other names 1

• Southlake Clinic Doing business as

Part of

Valley Internal Medicin

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

{
    "created_epoch": "1217894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274054400000",
    "number": "1386800753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 59028",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980582028",
            "telephone_number": "425-251-5110",
            "fax_number": "425-793-7458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3915 TALBOT RD S",
            "address_2": "SUITE 300",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980555738",
            "telephone_number": "425-251-5110",
            "fax_number": "425-793-7458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAKE CLINIC INC PS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHLAKE CLINIC INC PS",
        "enumeration_date": "2008-08-05",
        "last_updated": "2010-05-17",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "MARIANNE",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "425-251-5110",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southlake Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sound Association Western Washington LLC
• South Sound Inpatient Physicians PLLC
• South Sound Oncology Services, P.C.
• Southlake Clinic DME
• Southlake Clinic Inc PS
• Southlake Clinic Inc PS
• Southlake Clinic Inc PS
• Southlake Clinic Inc., P.S.
• Southlake Psychiatric Center
• Southlake Select, PC

• Durable Medical Equipment & Medical Supplies in Renton, WA
• Providers in Renton, WA by specialty
• Durable Medical Equipment & Medical Supplies in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2010; 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.