| |
2601 Sw Kenyon St Seattle WA 98126-3562 | |
(206) 923-2809 | |
(206) 923-2818 |
Full Name | |
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Speciality | Clinic/Center |
Location | 2601 Sw Kenyon St, Seattle, Washington |
Authorized Official Name and Position | Michael Erikson (CHIEF EXECUTIVE DIRECTOR) |
Authorized Official Contact | 2064616935 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1200 12th Ave S Ste 901 Seattle WA 98144-2712 Ph: (206) 548-3114 | 2601 Sw Kenyon St Seattle WA 98126-3562 Ph: (206) 923-2809 |
NPI Number | 1003975095 |
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Provider Enumeration Date | 12/06/2006 |
Last Update Date | 11/02/2023 |
Medicare PECOS PAC ID | 0143134205 |
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Medicare Enrollment ID | O20140310001791 |
Identifier | Type | State | Issuer |
---|---|---|---|
1003975095 | NPI | - | NPPES |
7123490 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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