| |
1200 12th Ave S Ste 901 Seattle WA 98144-2712 | |
(206) 548-3100 | |
Not Available |
Full Name | |
---|---|
Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 1200 12th Ave S Ste 901, Seattle, Washington |
Authorized Official Name and Position | Michael Erickson (CEO) |
Authorized Official Contact | 2065483100 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 3835 Seattle WA 98124-3835 Ph: () - | 1200 12th Ave S Ste 901 Seattle WA 98144-2712 Ph: (206) 548-3100 |
NPI Number | 1700395928 |
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Provider Enumeration Date | 09/20/2017 |
Last Update Date | 09/20/2017 |
Identifier | Type | State | Issuer |
---|---|---|---|
1700395928 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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