NPIMap

Organization Active NPI

Public Hospital District #1 of King County

Doing business as VMC Fairwood Primary Care

  • Adult Medicine Physician
  • Renton, WA
National Provider Identifier
1649227380
Registry record updated Jan 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
Legal business name
PUBLIC HOSPITAL DISTRICT #1 OF KING COUNTY
Doing business as
VMC Fairwood Primary Care
Practice address
14410 SE Petrovitsky Rd
Suite 104
Renton, WA 98058-8900
Phone
(425) 656-4242
NPI assigned
May 28, 2006
Last updated
Jan 15, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2008

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

Authorized official

Name
Melissa Farley, CPC
Title
Technical Coordinator
Phone
(425) 917-6282

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X NU
Adult Medicine Physician 207QA0505X NU Primary

Addresses

Primary practice location

14410 SE Petrovitsky Rd
Suite 104
Renton, WA 98058-8900

Mailing address

3600 Lind Ave SW
Suite 100
Renton, WA 98055-4934
Phone (425) 656-5412

Other identifiers 1

IdentifierTypeStateIssuer
7095839MedicaidWA

Other names 1

  • VMC Fairwood Primary Care Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200355200000",
    "number": "1649227380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 LIND AVE SW",
            "address_2": "SUITE 100",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980554934",
            "telephone_number": "425-656-5412",
            "fax_number": "425-656-5423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14410 SE PETROVITSKY RD",
            "address_2": "SUITE 104",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980588900",
            "telephone_number": "425-656-4242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUBLIC HOSPITAL DISTRICT #1 OF KING COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-28",
        "last_updated": "2008-01-15",
        "status": "A",
        "authorized_official_last_name": "FARLEY",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "TECHNICAL COORDINATOR",
        "authorized_official_telephone_number": "425-917-6282",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7095839",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VMC Fairwood Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Renton, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2008; 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.