Organization
OVERLAKE REPRODUCTIVE HEALTH INC PS.
Active
Other names
Overlake Reproductive Health Inc.- Ambulatory Surgical Facility
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN M JOHNSON MD (OWNER)
(425) 646-4700
Entity
Organization
Contact information
Practice address
11232 NE 15TH ST, SUITE 201, BELLEVUE, WA 98004-3739
(425) 646-4700
(253) 646-1076
Mailing address
11232 NE 15TH ST, SUITE 201, BELLEVUE, WA 98004-3739
(425) 646-4700
(253) 646-1076
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
ASF.FS.60350164
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ASF.FS.60350164
CERTIFICATION/LICENSE NUMBER
WA
Enumeration date
03/12/2014
Last updated
03/12/2014
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