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).
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 |
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 |
Entity Type | Entity Name | Entity Address |
---|---|---|
Washington State Corporations | SOUTHLAKE SELECT, PC | 4011 Talbot Rd S, 440, Renton, WA 98055-5791 |
Street Address |
4011 TALBOT RD S 440 |
City | RENTON |
State | WA |
Zip Code | 98055-5773 |
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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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 |
Find all providers in zip 98055 |
Taxonomy Code | 207R00000X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Internal Medicine |
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. |
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 |
Find all providers in RENTON |
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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.