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33431-13th Place South Federal Way WA 98003 | |
| (253) 874-7646 | |
| (253) 838-8364 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 33431-13th Place South, Federal Way, Washington |
| Authorized Official Name and Position | Vicki Hammond (CFO) |
| Authorized Official Contact | 4252771311 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
955 Powell Ave Sw Renton WA 98057-2908 Ph: (425) 277-1311 | 33431-13th Place South Federal Way WA 98003 Ph: (253) 874-7646 |
| NPI Number | 1104819788 |
|---|---|
| Provider Enumeration Date | 08/29/2005 |
| Last Update Date | 05/15/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104819788 | NPI | - | NPPES |
| 5034954 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 5016837 (Washington) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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