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830 Sw 116th St Seattle WA 98146-2257 | |
(425) 277-1311 | |
(425) 277-1566 |
Full Name | |
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Speciality | Clinic/Center |
Location | 830 Sw 116th St, Seattle, Washington |
Authorized Official Name and Position | Duane Nakamura (CREDENTIALING ANALYST) |
Authorized Official Contact | 4252771311 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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955 Powell Ave Sw Renton WA 98057-2908 Ph: (425) 277-1311 | 830 Sw 116th St Seattle WA 98146-2257 Ph: (425) 277-1311 |
NPI Number | 1174888119 |
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Provider Enumeration Date | 07/05/2012 |
Last Update Date | 07/05/2012 |
Medicare PECOS PAC ID | 9335042886 |
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Medicare Enrollment ID | O20200824002000 |
Identifier | Type | State | Issuer |
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1174888119 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 600461511 (Washington) | Primary |
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