SOUTHLAKE SELECT, PC


Address: 4011 Talbot Rd S, 440, Renton, WA 98055-5773
Phone: 4257934702

SOUTHLAKE SELECT, PC (NPI# 1548791924) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1548791924
Entity Type Organization
Organization Name SOUTHLAKE SELECT, PC
Practice Address 4011 Talbot Rd S
440
Renton
WA 98055-5773
Practice Telephone 4257934702
Practice Fax Number 4252715382
Mailing Telephone 4257934702
Mailing Fax Number 4252715382
Enumeration Date 2017-03-27
Last Update Date 2017-05-08
Authorized Official Name DR. DOMINICK ROBERT TOULOUSE (PRESIDENT)
Authorized Official Telephone 4257934702
Authorized Official Credential M.D.
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 305S00000X Point of Service 0020685 WA Managed Care Organizations
Y 207R00000X Internal Medicine Allopathic & Osteopathic Physicians

Other Data Sources

Entity Type Entity Name Entity Address
Washington State Corporations SOUTHLAKE SELECT, PC 4011 Talbot Rd S, 440, Renton, WA 98055-5791

Office Location

Street Address 4011 TALBOT RD S
440
City RENTON
State WA
Zip Code 98055-5773

Providers in the same location

NPI Name Taxonomy Address Enumeration
1528061694 Guy V Buell Specialist 4011 Talbot Rd S, Ste 440, Renton, WA 98055-5791 2005-05-23
1649756883 Amy Elizabeth Hardiman Physical Therapy Assistant 4011 Talbot Rd S, Renton, WA 98055-5773 2018-07-11
1336665959 Mary Elizabeth Walton Dietitian, Registered 4011 Talbot Rd S, Renton, WA 98055-5773 2017-08-15
1871031864 Abrey Lee Dietitian, Registered 4011 Talbot Rd S, Suite 100, Renton, WA 98055-5773 2017-02-09
1962940957 Kimberly Diana Konczak Dietitian, Registered 4011 Talbot Rd S, Suite 100, Renton, WA 98055-5773 2017-02-09
1578931325 Andrew S Huntley Physician Assistant 4011 Talbot Rd S, Suite 300, Renton, WA 98055-5773 2015-09-10
1285011080 Anne Macleod Registered Nurse 4011 Talbot Rd S, Renton, WA 98055-5773 2015-04-30
1508263716 Mie Hagiwara Physician Assistant 4011 Talbot Rd S, Suite 300, Renton, WA 98055-5773 2014-12-03
1073921813 Zachary A. Bowman Physician Assistant 4011 Talbot Rd S, Suite 300, Renton, WA 98055-5773 2014-07-24
1851706295 Niharika Rath Allergy & Immunology 4011 Talbot Rd S, Renton, WA 98055-5773 2014-06-24
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1356965750 Proliance Surgery Center At Valley, LLC Clinic/Center 4009 Talbot Road S, Suite 200, Renton, WA 98055 2020-06-01
1851804959 Talbot Rehabilitation Center, LLC Skilled Nursing Facility 4430 Talbot Road South, Renton, WA 98055 2017-11-10
1154878668 Nelson Family Dentistry Dentist 19221 108th Ave Se Suite #2, Renton, WA 98055 2016-09-01
1598182990 Annie Kyunga Ahn Otolaryngology 4033 Talbot Rd S Ste 540, Renton, WA 98055 2014-03-24
1376960138 Madhuri Gordhan Patel Registered Nurse 3501 Mill Place South, Renton, WA 98055 2014-03-18
1912331042 Karen Dohr Pharmacist 400 S. 43 Street, Renton, WA 98055 2013-08-26
1659637668 Benjamin Reiss Ophthalmology 4300 Talbot Rd S Ste 300, Renton, WA 98055 2012-04-03
1205137940 Duy Ai Quang Hoang Pharmacist 9431 S 196th Pl, Renton, WA 98055 2010-11-11
1972823664 Erica L Ellzey Physical Therapist 18623 112th Ave Se, Renton, WA 98055 2010-06-04
1588984587 Melissa A. Jordan Nurse Anesthetist, Certified Registered 4011 Talbot Rd., 5th Floor, Renton, WA 98055 2010-06-02
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Taxonomy Information

Taxonomy Code 207R00000X
Grouping Allopathic & Osteopathic Physicians
Classification Internal Medicine

Taxonomy Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source]
- Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1760541734 Debra Susan Fetherston Internal Medicine 275 Bronson Way Ne, Renton, WA 98056-4030 2006-12-06
1043318629 Khairunnissa S Rajwani Internal Medicine 2418 Se 2nd Pl, Renton, WA 98056-8876 2006-09-20
1235146077 Emad Nabil Girgis Internal Medicine 17600 Talbot Rd S, Suite 5, Renton, WA 98055-5788 2006-08-02
1447270970 Gene Y Hao Internal Medicine 606 Oakesdale Ave Sw, Suite C200, Renton, WA 98057-5227 2006-07-20
1205860509 Marta E Long Internal Medicine 275 Bronson Way Se, Renton, WA 98056 2006-07-10
1700812237 Margaret R Adam Internal Medicine 64 Rainier Ave S, Renton, WA 98057 2006-06-25
1952369498 Khue Dung Lucy Nguyen Internal Medicine 660 Sw 39th St, Ste 150, Renton, WA 98057-4912 2006-05-03
1013987841 Ting-wei Yang Internal Medicine 4011 Talbot Rd S Ste 500, Renton, WA 98055-5782 2006-01-24
1417939331 James Robert Fackelman Internal Medicine 10555 Se Carr Rd, Renton, WA 98055-5820 2005-11-16
1730172008 Margaret Fillmore Gaines Internal Medicine 606 Oakesdale Ave Sw Ste C200, Renton, WA 98057 2005-08-23
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Competitor

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City RENTON
Zip Code 98055

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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