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MARANATHA MEDICAL CLINIC INC P S
NPI 1063748861
Clinic/Center in Renton, WA

Active since October 29, 2009CLIA 50D0883125 · Microscopy
17900 TALBOT RD S, #101, RENTON, WA 98055(425) 235-9614(425) 235-1060 Get Directions Write a Review

NPPES record last updated: September 11, 2017. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Maranatha Medical Clinic Inc P S NPPES

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

MARANATHA MEDICAL CLINIC INC P S (NPI 1063748861) is a healthcare organization registered as a clinic/center in Renton, Washington and active in the NPI registry since October 2009. The organization holds a CLIA Microscopy certificate valid through April 4, 2028 and lists Daniel L Graves, President, as its authorized official.

NPPES Registry Identity

NPI1063748861
Entity TypeOrganization
Primary Taxonomy261Q00000X
Legal Business NameMARANATHA MEDICAL CLINIC INC P S
Location Address17900 TALBOT RD S, #101Renton, WA 98055-8212
Mailing Address17900 Talbot Road South, #101Renton, WA 98055-8636 · (425) 235-9614 · Fax (425) 235-1060
Phone(425) 235-9614
Fax(425) 235-1060
Organization SubpartNo
Authorized OfficialDaniel L GravesPresident · (425) 235-9614
Enumeration DateOctober 29, 2009
Last NPPES UpdateSeptember 11, 2017
✔ NPI 1063748861 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities
Taxonomy Code261Q00000X
License✔ Licensed in WA · 17917
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
17900 TALBOT RD S, Renton, WA 98055
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 50D0883125

Maranatha Medical · Renton, WA
Active · expires Apr 4, 2028
CLIA Number50D0883125
Laboratory TypePhysician Office
Certificate Effective DateFebruary 25, 1994
Certificate Expiration DateApril 4, 2028
Laboratory DirectorStacey L. Hiles
Laboratory Phone(425) 235-9614
Laboratory LocationMaranatha Medical17900 Talbot Rd S, #101, Renton, WA 98055
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES 10

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

STACEY L. HILES, M.D., PLLC
Clinic/Center (Primary Care)
17900 TALBOT RD S, SUITE 101
RENTON, WA 98055
King County (425) 235-9614
MARANATHA MEDICAL CLINIC INC P S
Internal Medicine
17900 TALBOT RD S, #101
RENTON, WA 98055
King County (425) 235-9614
DR. DANIEL LEAHY GRAVES MD
Legal Medicine
17900 TALBOT RD S, #101
RENTON, WA 98055
King County (425) 235-9614
DR. CRAIG M MCGORAN MD
Family Medicine
17900 TALBOT RD S, #102
RENTON, WA 98055
King County (425) 255-9310
DR. WILLIAM RONALD WILKINSON ED.D.
Psychologist
17900 TALBOT RD S, SUITE 102
RENTON, WA 98055
King County (253) 351-2194
LUKE ST. MARIE
Dentist
17900 TALBOT RD S, STE #103
RENTON, WA 98055
King County (425) 271-1727
DR. LEIGH CHRISTINE KENNER DDS
Dentist (General Practice)
17900 TALBOT RD S, SUITE 103
RENTON, WA 98055
King County (425) 271-1727
DR. GARY H KATO MD
Family Medicine
17900 TALBOT RD S, #102
RENTON, WA 98055
King County (425) 255-9310

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Maranatha Medical Clinic Inc P S's NPI number?

The NPI number for Maranatha Medical Clinic Inc P S is 1063748861. It was assigned to this organization in the NPPES registry on October 29, 2009.

Where is Maranatha Medical Clinic Inc P S located?

Maranatha Medical Clinic Inc P S is located at 17900 Talbot Rd S #101, Renton, WA 98055. The listed phone number is (425) 235-9614.

What is Maranatha Medical Clinic Inc P S's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Does Maranatha Medical Clinic Inc P S hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 50D0883125) is associated with this NPI, valid through April 4, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Maranatha Medical Clinic Inc P S was last updated on September 11, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.