| |
1215 S 11th St Tacoma WA 98405-4020 | |
(253) 280-9840 | |
(253) 272-1952 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 1215 S 11th St, Tacoma, 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 |
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Po Box 34703 Seattle WA 98124-1703 Ph: () - | 1215 S 11th St Tacoma WA 98405-4020 Ph: (253) 280-9840 |
NPI Number | 1083002224 |
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Provider Enumeration Date | 12/22/2014 |
Last Update Date | 01/31/2025 |
Identifier | Type | State | Issuer |
---|---|---|---|
1083002224 | NPI | - | NPPES |
2043964 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | (* (Not Available)) | Secondary |
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 6005372781 (Washington) | Primary |
Olympic Dental & Denture Center, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 3720 6th Ave, Suite A, Tacoma, WA 98406 Phone: 253-752-1320 Fax: 253-752-1425 | |
Bansuk Ju Dds Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2302 S Union Ave Ste A6, Tacoma, WA 98405 Phone: 253-752-4422 | |