NPIMap

Organization Active NPI

Lakeshore Clinic PLLC

  • Family Medicine Physician
  • Bothell, WA
National Provider Identifier
1841399870
Registry record updated Oct 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LAKESHORE CLINIC PLLC
Practice address
10025 NE 186TH St
Bothell, WA 98011-3839
Phone
(425) 486-9131
Fax
(425) 486-9490
NPI assigned
Sep 22, 2006
Last updated
Oct 11, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2012

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

Authorized official

Name
Linda R Jeppesen
Title
Ceo
Phone
(425) 486-9131

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary
Internal Medicine Physician 207R00000X

Addresses

Primary practice location

10025 NE 186TH St
Bothell, WA 98011-3839

Mailing address

PO Box 646
Bothell, WA 98041-0646
Phone (425) 485-3955

Other names 1

  • Lakeshore Clinic Bothell Other name

National Provider Directory

National Provider Directory

Locations

10030 NE 185TH St at Bothell
Bothell, WA 98011
Phone (206) 486-9131

515 State St S
Kirkland, WA 98033
Phone (206) 827-9711

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349913600000",
    "number": "1841399870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 646",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980410646",
            "telephone_number": "425-485-3955",
            "fax_number": "425-485-1476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10025 NE 186TH ST",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980113839",
            "telephone_number": "425-486-9131",
            "fax_number": "425-486-9490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2012-10-11",
        "status": "A",
        "authorized_official_last_name": "JEPPESEN",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "425-486-9131"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeshore Clinic Bothell",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bothell, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2012; 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.