| Seattle Indian Health Board | |
|
611 12th Ave S Suite 200 Seattle WA 98144-1910 | |
| (206) 324-9360 | |
| (206) 324-8910 |
| Full Name | Seattle Indian Health Board |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 611 12th Ave S, Seattle, Washington |
| Authorized Official Name and Position | Esther Lucero (CEO) |
| Authorized Official Contact | 2063249360 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Seattle Indian Health Board 611 12th Ave S Seattle WA 98144-1910 Ph: (206) 324-9360 | Seattle Indian Health Board 611 12th Ave S Suite 200 Seattle WA 98144-1910 Ph: (206) 324-9360 |
| NPI Number | 1306911458 |
|---|---|
| Provider Enumeration Date | 11/22/2006 |
| Last Update Date | 03/12/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306911458 | NPI | - | NPPES |
| 5010954 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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