# EMERALD CITY SPORTS & SPINE MEDICINE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lake Washington Sports & Spine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992074066
- **Authorized official:** GARRETT S HYMAN MD, MPH (PHYSICIAN OWNER)
- **Authorized official phone:** (206) 852-8898

## Contact information

- **Practice address:** 1632 116TH AVE NE, STE C, BELLEVUE, WA 98004-3035
- **Practice address phone:** (425) 818-0558
- **Practice address fax:** (888) 557-3062
- **Mailing address:** 6924 SE ALLEN ST, MERCER ISLAND, WA 98040-3357
- **Mailing address phone:** (206) 852-8898

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | MD 39116 | WA | Yes |

## Other

- **Enumeration date:** 12/20/2011
- **Last updated:** 02/22/2012