Healthcare Provider Details

I. General information

NPI: 1861432726
Provider Name (Legal Business Name): OVERLAKE MEDICAL CENTER & CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 116TH AVE NE
BELLEVUE WA
98004-4604
US

IV. Provider business mailing address

1035 116TH AVENUE NE
BELLEVUE WA
98004
US

V. Phone/Fax

Practice location:
  • Phone: 425-688-5000
  • Fax: 425-688-5658
Mailing address:
  • Phone: 425-688-5000
  • Fax: 425-688-5658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberH131
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier500051
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerMEDICARE PROVIDER NUMBER
# 2
Identifier1020765
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name: JONATHAN DUARTE
Title or Position: CEO
Credential:
Phone: 425-688-5784