| Lakeshore Clinic Pllc | |
|
10131 Main St Bothell WA 98011-3425 | |
| (425) 485-3955 | |
| (425) 485-1476 |
| Full Name | Lakeshore Clinic Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 10131 Main St, Bothell, Washington |
| Authorized Official Name and Position | Linda R Jeppesen (CEO) |
| Authorized Official Contact | 4254853955 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeshore Clinic Pllc Po Box 646 Bothell WA 98041-0646 Ph: (425) 485-3955 | Lakeshore Clinic Pllc 10131 Main St Bothell WA 98011-3425 Ph: (425) 485-3955 |
| NPI Number | 1922052422 |
|---|---|
| Provider Enumeration Date | 05/19/2006 |
| Last Update Date | 02/18/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922052422 | NPI | - | NPPES |
| G217116700 | Other | WA | PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 213E00000X | Podiatrist | (* (Not Available)) | Secondary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
King County Public Hospital District No 2 Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 10131 Main St, Bothell, WA 98011 Phone: 425-485-3955 Fax: 425-485-1476 | |
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