| |
6020 35th Ave Sw Seattle WA 98126-3002 | |
(206) 461-6950 | |
(206) 461-8542 |
Full Name | |
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Speciality | Clinic/Center |
Location | 6020 35th Ave Sw, Seattle, Washington |
Authorized Official Name and Position | Michael Erikson (CHIEF EXECUTIVE OFFICER) |
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 South Suite 901 Seattle WA 98144 Ph: (206) 548-3114 | 6020 35th Ave Sw Seattle WA 98126-3002 Ph: (206) 461-6950 |
NPI Number | 1871523811 |
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Provider Enumeration Date | 07/04/2006 |
Last Update Date | 01/12/2018 |
Medicare PECOS PAC ID | 0143134205 |
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Medicare Enrollment ID | O20101115000625 |
Identifier | Type | State | Issuer |
---|---|---|---|
1871523811 | NPI | - | NPPES |
7115975 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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