SOUTHLAKE CLINIC INC., P.S.
NPI 1104962331
Internal Medicine in Renton, WA

Q: What is Southlake Clinic Inc., P.S.'s NPI number?

The NPI number for Southlake Clinic Inc., P.S. is 1104962331. It was assigned to this organization in the NPPES registry on January 29, 2007. The provider was formerly known as Valley Internal Medicine Inc Ps.

Q: What is Southlake Clinic Inc., P.S.'s specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Active since January 29, 2007

4011 TALBOT RD S, SUITE 500, RENTON, WA 98055(425) 251-5110(425) 793-4707 Get Directions Write a Review

NPPES record last updated: July 13, 2017. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jul 13, 2017, May 16, 2017 (2 updates tracked since 2017).

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About Southlake Clinic Inc., P.s. NPPES

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

SOUTHLAKE CLINIC INC., P.S. (NPI 1104962331), doing business as Valley Internal Medicine Inc Ps, is a healthcare organization registered as an internal medicine in Renton, Washington and active in the NPI registry since January 2007. The organization lists James Dwight Hudson, Coo, as its authorized official.

NPPES Registry Identity

NPI1104962331

Entity TypeOrganization

Primary Taxonomy207R00000X

Legal Business NameSOUTHLAKE CLINIC INC., P.S.

Location Address4011 TALBOT RD S, SUITE 500Renton, WA 98055-5773

Mailing AddressPo Box 59028Renton, WA 98058-2028 · (425) 251-5110 · Fax (425) 277-1301

Phone(425) 251-5110

Fax(425) 793-4707

Organization SubpartNo

Authorized OfficialJames Dwight HudsonCoo · (425) 793-4725

Enumeration DateJanuary 29, 2007

Last NPPES UpdateJuly 13, 20172 updates tracked since enumeration

✔ NPI 1104962331 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 15

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207R00000X

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.

Also ListedDermatologyTaxonomy 207N00000X

Also ListedInternal Medicine · Cardiovascular DiseaseTaxonomy 207RC0000X

Also ListedInternal Medicine · Critical Care MedicineTaxonomy 207RC0200X

Also ListedInternal Medicine · Endocrinology, Diabetes & MetabolismTaxonomy 207RE0101X

Also ListedInternal Medicine · GastroenterologyTaxonomy 207RG0100X

Also ListedInternal Medicine · Hematology & OncologyTaxonomy 207RH0003X

Also ListedInternal Medicine · Interventional CardiologyTaxonomy 207RI0011X

Also ListedInternal Medicine · Infectious DiseaseTaxonomy 207RI0200X

Also ListedInternal Medicine · Pulmonary DiseaseTaxonomy 207RP1001X

Also ListedInternal Medicine · Sleep MedicineTaxonomy 207RS0012X

Also ListedNuclear Medicine · Nuclear CardiologyTaxonomy 207UN0901X

Also ListedHospitalistTaxonomy 208M00000X

Also ListedPhysician AssistantTaxonomy 363A00000X

Also ListedNurse PractitionerTaxonomy 363L00000X

4011 TALBOT RD S, Renton, WA 98055

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Other Names 1

Former Legal Business NameValley Internal Medicine Inc Ps

Other Identifiers 5

Other0057600WA · L&i

Medicare PING217115400WA

OtherCS3809WA · Rr Medicare

Medicaid7072440WA

Medicare NSC0526970001WA

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 20

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

DR. FREDERICK PARK M.D., PH.D.

Internal Medicine (Gastroenterology)

4011 TALBOT RD S, STE 500
RENTON, WA 98055

King County (425) 251-5110

CHAD CARSON MOLONEY PA-C

Physician Assistant (Surgical)

4011 TALBOT RD S, SUITE 300
RENTON, WA 98055

King County (425) 656-5060

KELSEY REGAN PLATT ARNP

Nurse Practitioner

4011 TALBOT RD S, SUITE 300
RENTON, WA 98055

King County (425) 656-5060

DOMINICK R TOULOUSE MD

Internal Medicine

4011 TALBOT RD S, SUITE 440
RENTON, WA 98055

King County (425) 793-4702

MRS. CHRISTINA MICHELLE JANDER PA-C

Physician Assistant

4011 TALBOT RD S, SUITE 300
RENTON, WA 98055

King County (425) 656-5060

ROY D YEN MD

Internal Medicine (Gastroenterology)

4011 TALBOT RD S, STE 500
RENTON, WA 98055

King County (425) 251-5110

DANIEL P O'NEILL MD

Internal Medicine (Gastroenterology)

4011 TALBOT RD S, SUITE 500
RENTON, WA 98055

King County (425) 251-5110

PUBLIC HOSPITAL DISTRICT #1 OF KING COUNTY

Surgery

4011 TALBOT RD S, SUITE 420
RENTON, WA 98055

King County (425) 251-1322

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 Southlake Clinic Inc., P.S.'s NPI number?

The NPI number for Southlake Clinic Inc., P.S. is 1104962331. It was assigned to this organization in the NPPES registry on January 29, 2007. The provider was formerly known as Valley Internal Medicine Inc Ps.

Where is Southlake Clinic Inc., P.S. located?

Southlake Clinic Inc., P.S. is located at 4011 Talbot Rd S Suite 500, Renton, WA 98055. The listed phone number is (425) 251-5110.

What is Southlake Clinic Inc., P.S.'s specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

When was this NPI record last updated?

The NPPES record for Southlake Clinic Inc., P.S. was last updated on July 13, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.