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9650 15th Ave Sw Seattle WA 98106-2576 | |
| (206) 965-1005 | |
| (206) 965-1042 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 9650 15th Ave Sw, Seattle, Washington |
| Authorized Official Name and Position | Mary Bartolo (DEPUTY DIRECTOR) |
| Authorized Official Contact | 2067883224 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 34703 Seattle WA 98124-1703 Ph: () - | 9650 15th Ave Sw Seattle WA 98106-2576 Ph: (206) 965-1005 |
| NPI Number | 1023154077 |
|---|---|
| Provider Enumeration Date | 01/29/2007 |
| Last Update Date | 01/31/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023154077 | NPI | - | NPPES |
| 2004843 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 6005372781 (Washington) | Primary |
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