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Organization
OVER LAKE MEDICAL CENTER
Active
Organization
OVER LAKE MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIER JORDAN-KEITH (PRACTICE SUPERVISOR)
(425) 688-5846
Entity
Organization
Contact information
Practice address
1750 112TH AVE NE, SUITE A101, BELLEVUE, WA 98004-3752
(425) 688-5234
Mailing address
1750 112TH AVE NE, SUITE A101, BELLEVUE, WA 98004-3752
(425) 688-5234
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
AP60481748
WA
Other
Enumeration date
12/24/2014
Last updated
12/24/2014
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