SOUTHLAKE CLINIC INC PS
NPI 1043368426
Clinic/Center - Ambulatory Surgical in Renton, WA

Q: What is Southlake Clinic Inc Ps's NPI number?

The NPI number for Southlake Clinic Inc Ps is 1043368426. It was assigned to this organization in the NPPES registry on January 8, 2007.

Q: What is Southlake Clinic Inc Ps's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.

Active since January 08, 2007

4011 TALBOT ROAD SOUTH, SUITE 500, RENTON, WA 98055(425) 251-5110(425) 793-4710 Get Directions Write a Review

NPPES record last updated: November 20, 2012. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Southlake Clinic Inc Ps NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHLAKE CLINIC INC PS (NPI 1043368426) is a healthcare organization registered as an ambulatory surgical in Renton, Washington and active in the NPI registry since January 2007. The organization lists Marianne Larson, Director Of Operations, as its authorized official.

NPPES Registry Identity

NPI1043368426

Entity TypeOrganization

Primary Taxonomy261QA1903X

Legal Business NameSOUTHLAKE CLINIC INC PS

Location Address4011 TALBOT ROAD SOUTH, SUITE 500Renton, WA 98055

Mailing AddressPo Box 59028Renton, WA 98058-2028 · (425) 251-5110 · Fax (425) 793-7458

Phone(425) 251-5110

Fax(425) 793-4710

Organization SubpartNo

Authorized OfficialMarianne LarsonDirector Of Operations · (425) 251-5110

Enumeration DateJanuary 8, 2007

Last NPPES UpdateNovember 20, 2012

✔ NPI 1043368426 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities

Taxonomy Code261QA1903X

License✔ Licensed in WA · FS.60293976

Also ListedClinic/Center · EndoscopyTaxonomy 261QE0800X · License FS.60293976 (WA)

4011 TALBOT ROAD SOUTH, Renton, WA 98055

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Other Identifiers 4

Medicaid7083660WA

Other490003337WA · Railroad Medicare

Other0119463WA · L&i

Medicare PIN217000856WA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include PacificSource Health Plans.Insurance ›

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CHRISTOPHER A DIRE MD

Internal Medicine (Gastroenterology)