SOUTHLAKE CLINIC INC PS – Ambulatory Surgical Clinic/Center, NPI 1043368426

SOUTHLAKE CLINIC INC PS is a healthcare provider. based in Renton, Washington. specializing in Ambulatory Surgical Clinic/Center. The organization holds a License No. FS.60293976 (WA). The NPI Number for SOUTHLAKE CLINIC INC PS is 1043368426

Main info

Organization
Name
SOUTHLAKE CLINIC INC PS
NPI
1043368426
Phone
(425) 251-5110
Address
PO BOX 59028
Authorized Official
MARIANNE LARSON DIRECTOR OF OPERATIONS
Enumeration Date
8 January 2007
Last Update Date
20 November 2012
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience57
Completeness75
Years active:19State licenses:1Digital endpointsOther names

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Provider Addresses for SOUTHLAKE CLINIC INC PS

  • PO BOX 59028

    RENTON, WA 980582028

    Phone: (425) 251-5110

    Fax: (425) 793-7458

    Type: Mailing

  • Talbot Professional Center, 4011, Talbot Road South, Renton, King County, Washington, 98055, United States

    SUITE 500

    RENTON, WA 98055

    Phone: (425) 251-5110

    Fax: (425) 793-4710

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

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Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 98058)

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Reviews

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Frequently asked questions

How do payers reference SOUTHLAKE CLINIC INC PS?
For SOUTHLAKE CLINIC INC PS, use NPI 1043368426 as the unique 10-digit identifier.
Active or inactive — what applies to SOUTHLAKE CLINIC INC PS?
You should see SOUTHLAKE CLINIC INC PS as active in CMS-hosted NPPES data.
What clinical focus is listed for SOUTHLAKE CLINIC INC PS?
At a glance, SOUTHLAKE CLINIC INC PS is tied to Ambulatory Surgical Clinic/Center. Clinical services aligned with this taxonomy classification.
Where in Washington is SOUTHLAKE CLINIC INC PS registered?
Use Renton, Washington as the headline location for SOUTHLAKE CLINIC INC PS here.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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