Organization
SOUTHLAKE CLINIC INC., P.S.
Active
Organization
SOUTHLAKE CLINIC INC., P.S.
Active
Other names
Valley Internal Medicine Inc PS
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES DWIGHT HUDSON MHA (COO)
(425) 793-4725
Entity
Organization
Contact information
Practice address
4011 TALBOT RD S, SUITE 500, RENTON, WA 98055-5773
(425) 251-5110
(425) 793-4707
Mailing address
PO BOX 59028, RENTON, WA 98058-2028
(425) 251-5110
(425) 277-1301
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RH0003X
Hematology & Oncology Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
—
207RI0200X
Infectious Disease Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207RS0012X
Sleep Medicine (Internal Medicine) Physician
—
—
207UN0901X
Nuclear Cardiology Physician
—
—
208M00000X
Hospitalist Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0057600
L&I
WA
05
—
7072440
—
WA
01
—
CS3809
RR MEDICARE
WA
Enumeration date
01/29/2007
Last updated
07/13/2017
Update your record
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