| |
908 Jefferson St Fl 11 Seattle WA 98104-2433 | |
(206) 744-3950 | |
(206) 744-4151 |
Full Name | |
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Speciality | Clinic/Center |
Location | 908 Jefferson St Fl 11, Seattle, Washington |
Authorized Official Name and Position | Kevin Ardell Moe (PROVIDER ENROLLMENT SPECIALIST) |
Authorized Official Contact | 2062638807 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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401 5th Ave Ste 1000 Seattle WA 98104-1818 Ph: (425) 263-8414 | 908 Jefferson St Fl 11 Seattle WA 98104-2433 Ph: (206) 744-3950 |
NPI Number | 1295383958 |
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Provider Enumeration Date | 08/27/2019 |
Last Update Date | 08/27/2019 |
Medicare PECOS PAC ID | 8022913789 |
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Medicare Enrollment ID | O20161107001885 |
Identifier | Type | State | Issuer |
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1295383958 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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