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2781 S 242nd St Des Moines WA 98198-5166 | |
| (206) 957-9040 | |
| (206) 212-4525 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 2781 S 242nd St, Des Moines, Washington |
| Authorized Official Name and Position | Rogelio Riojas (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2067883226 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 34703 Seattle WA 98124-1703 Ph: (253) 681-6633 | 2781 S 242nd St Des Moines WA 98198-5166 Ph: (206) 957-9040 |
| NPI Number | 1528432010 |
|---|---|
| Provider Enumeration Date | 11/20/2015 |
| Last Update Date | 01/31/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528432010 | NPI | - | NPPES |
| 2201757 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 6005372781 (Washington) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 6005372781 (Washington) | Primary |
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