| |
1537 Western Ave Seattle WA 98101-1521 | |
(206) 728-4143 | |
(206) 682-0363 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 1537 Western Ave, Seattle, Washington |
Authorized Official Name and Position | Mark Llody Secord (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 2064616935 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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905 Spruce St Ste. 300 Seattle WA 98104-2474 Ph: (206) 461-6935 | 1537 Western Ave Seattle WA 98101-1521 Ph: (206) 728-4143 |
NPI Number | 1558549857 |
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Provider Enumeration Date | 02/08/2008 |
Last Update Date | 05/07/2009 |
Identifier | Type | State | Issuer |
---|---|---|---|
1558549857 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 600138418118 (Washington) | Primary |
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