Organization Name: | SOUTHLAKE CLINIC DME |
NPI Number: | 1821237488 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARIANNE LARSON (CHEIF OPERATING OFFICER) |
Mailing Address: | 4033 Talbot Rd S Suite 500 Renton |
State: | WA US |
Postal Code: | 980555772 |
Phone Number: | 4252515110 |
Fax Number: | 4257937382 |
NPI Enumeration Date: | 02/05/2009 |
NPI Last Update Date: | 05/17/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | 600 052 154 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |