Organization
PUBLIC HOSPITAL DISTRICT #1 OF KING COUNTY
Active
Other names
VMC Fairwood Primary Care
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA FARLEY CPC (TECHNICAL COORDINATOR)
(425) 917-6282
Entity
Organization
Contact information
Practice address
14410 SE PETROVITSKY RD, SUITE 104, RENTON, WA 98058-8900
(425) 656-4242
Mailing address
3600 LIND AVE SW, SUITE 100, RENTON, WA 98055-4934
(425) 656-5412
(425) 656-5423
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7095839
—
WA
Enumeration date
05/28/2006
Last updated
01/15/2008
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