Southlake Clinic DME

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

600 052 154 Issued in WA

Legal business name

SOUTHLAKE CLINIC DME

Practice address

4033 Talbot Rd S
Suite 500
Renton, WA 98055-5772

Phone

(425) 251-5110

Fax

(425) 793-7382

NPI assigned

Feb 5, 2009

Organization subpart

Yes

Parent organization

SOUTHLAKE CLINIC, INC., P.S.As reported in NPPES

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

Authorized official

Name

Marianne Larson

Title

Cheif Operating Officer

Phone

(425) 251-5110

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Valley Internal Medicin2 organizations share this tax ID, including this one

Part of

Valley Internal Medicin

Other organizations with this tax ID 1

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

• Southlake Clinic Inc PS

  • Clinical Medical Laboratory
  • Renton, WA
  • NPI 1548319171
  NPD tax ID

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Southlake Clinic Inc., P.S.

  • Internal Medicine Physician
  • Renton, WA
  • NPI 1104962331
  NPPES parent name

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

{
    "created_epoch": "1233792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274054400000",
    "number": "1821237488",
    "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": "4033 TALBOT RD S",
            "address_2": "SUITE 500",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980555772",
            "telephone_number": "425-251-5110",
            "fax_number": "425-793-7382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAKE CLINIC DME",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHLAKE CLINIC, INC., P.S.",
        "enumeration_date": "2009-02-05",
        "last_updated": "2010-05-17",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "MARIANNE",
        "authorized_official_title_or_position": "CHEIF OPERATING OFFICER",
        "authorized_official_telephone_number": "425-251-5110"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "WA",
            "license": "600 052 154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9062571",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melody Soucy, ARNP
• Michele K Souligny, RN, MSN-ED
• Sound Association Western Washington LLC
• South Sound Inpatient Physicians PLLC
• South Sound Oncology Services, P.C.
• Southlake Clinic Inc PS
• Southlake Clinic Inc PS
• Southlake Clinic Inc PS
• Southlake Clinic Inc PS
• Southlake Clinic Inc., P.S.

• 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.