Organization
LAKE FOREST PARK CLINIC TR
Active
Other names
Lake Forest Park Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHARLES WILLIAM SCHNEIDER (PRES/CEO)
(206) 368-1700
Entity
Organization
Contact information
Practice address
17191 BOTHELL WAY NE, LAKE FOREST PARK, WA 98155-5534
(206) 365-6768
(206) 364-5418
Mailing address
17191 BOTHELL WAY NE, SUITE 205, LAKE FOREST PARK, WA 98155-5534
(206) 365-6768
(206) 364-5418
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CJ6346
RAILROAD MEDICARE
WA
Enumeration date
04/06/2006
Last updated
04/21/2011
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