1891883435 NPI number — KING COUNTY PUBLIC HOSPITAL DISTRICT NO 2

Table of content: MRS. MICHELLE SHAKE EDMONDS PHARMD (NPI 1609371533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891883435 NPI number — KING COUNTY PUBLIC HOSPITAL DISTRICT NO 2

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KING COUNTY PUBLIC HOSPITAL DISTRICT NO 2
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891883435
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 34036
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98124-1036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-899-3292
Provider Business Mailing Address Fax Number:
425-899-3269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12040 NE 128TH ST
Provider Second Line Business Practice Location Address:
MS 105
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98034-3013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-899-2560
Provider Business Practice Location Address Fax Number:
425-899-2079
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MYCROFT
Authorized Official First Name:
TINA
Authorized Official Middle Name:
CHRISTINE
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
425-899-2606

Provider Taxonomy Codes

  • Taxonomy code: 207VX0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CJ9678 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: CQ2437 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: CG8137 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7127426 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CG2833 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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