Lake Forest Park Clinic TR

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

LAKE FOREST PARK CLINIC TR

Doing business as

Lake Forest Park Medical Clinic

Practice address

17191 Bothell Way NE
Lake Forest Park, WA 98155-5534

Phone

(206) 365-6768

Fax

(206) 364-5418

NPI assigned

Apr 6, 2006

Last updated

Apr 21, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Charles William Schneider

Title

Pres/Ceo

Phone

(206) 368-1700

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lake Forest Park Medical Clinic Doing business as

Locations

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

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303344000000",
    "number": "1548222102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17191 BOTHELL WAY NE",
            "address_2": "SUITE 205",
            "city": "LAKE FOREST PARK",
            "state": "WA",
            "postal_code": "981555534",
            "telephone_number": "206-365-6768",
            "fax_number": "206-364-5418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17191 BOTHELL WAY NE",
            "city": "LAKE FOREST PARK",
            "state": "WA",
            "postal_code": "981555534",
            "telephone_number": "206-365-6768",
            "fax_number": "206-364-5418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE FOREST PARK CLINIC TR",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-06",
        "last_updated": "2011-04-21",
        "status": "A",
        "authorized_official_last_name": "SCHNEIDER",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRES/CEO",
        "authorized_official_telephone_number": "206-368-1700",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CJ6346",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Forest Park Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kent N Sullivan MD PLLC
• Niki Christine King
• Melinda Kloepfer Rice, ARNP
• Kelly Marie Knickerbocker, MSN ARNP PMHNP
• Lake Forest Park Acupuncture and Massage
• Lake Forest Vision
• Daisy Abutin Lalas, NURSE CASE MANAGER
• Rebecca Carolyn Langseth
• Linda Renee Lusk-Fauquet, ARNP
• Cristina Nadine Maldonado, MSW

• Family Medicine Physician in Lake Forest Park, WA
• Providers in Lake Forest Park, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2011; 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.