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1116 Summit Ave Seattle WA 98101-2831 | |
| (206) 726-4100 | |
| (206) 328-3757 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1116 Summit Ave, Seattle, Washington |
| Authorized Official Name and Position | Sean Potter (BILLING MANAGER) |
| Authorized Official Contact | 2063230930 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
5802 Rainier Ave S Seattle WA 98118-2706 Ph: (206) 723-1980 | 1116 Summit Ave Seattle WA 98101-2831 Ph: (206) 726-4100 |
| NPI Number | 1467544171 |
|---|---|
| Provider Enumeration Date | 09/29/2006 |
| Last Update Date | 05/09/2024 |
| Certification Date | 05/09/2024 |
| Medicare PECOS PAC ID | 4284891052 |
|---|---|
| Medicare Enrollment ID | O20200924001786 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467544171 | NPI | - | NPPES |
| 1990001 | Medicaid | WA |
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