Organization
LAKE HILLS MEDICAL ASSOC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY L LARSON (OFFICE MANAGER)
(208) 798-8968
Entity
Organization
Contact information
Practice address
14858 LAKE HILLS BLVD, BELLEVUE, WA 98007-5821
(208) 816-1332
Mailing address
1525 BURRELL DR, LEWISTON, ID 83501-5827
(208) 816-1332
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00015580
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7081771
—
WA
Enumeration date
01/17/2006
Last updated
01/07/2011
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