Lake Tye Emergency Physicians PLLC

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

Legal business name

LAKE TYE EMERGENCY PHYSICIANS PLLC

Practice address

14701 179TH Ave SE
Monroe, WA 98272-1108

Phone

(360) 794-7497

NPI assigned

Oct 29, 2013

Organization subpart

No

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

Authorized official

Name

Charles Mitchell, MD

Title

President

Phone

(469) 401-2386

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1383004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383004800000",
    "number": "1467880518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13737 NOEL RD",
            "address_2": "STE 1600",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752401331",
            "telephone_number": "469-401-2386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14701 179TH AVE SE",
            "city": "MONROE",
            "state": "WA",
            "postal_code": "982721108",
            "telephone_number": "360-794-7497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE TYE EMERGENCY PHYSICIANS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-29",
        "last_updated": "2013-10-29",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "469-401-2386",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Kei Kung, L.M.P.
• Richard Kurfess
• Kyle D Gill PLLC
• Jessica Kyllonen
• Laboratory Corporation of America
• Deborah Marie Lambo, MA, LMHC
• Kelly Angela Landon, CPSST
• Ginger Lee Landry, LMP
• Matthew Patrick Langedyke, MSW, LICSW
• Caroline Lara, MA

• Emergency Medicine Physician in Monroe, WA
• Providers in Monroe, WA by specialty
• Emergency Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2013; 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.