| |
301 21st Ave E Seattle WA 98112-5318 | |
(206) 940-2165 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 301 21st Ave E, Seattle, Washington |
Authorized Official Name and Position | Mark Secord (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 2065483050 |
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: () - | 301 21st Ave E Seattle WA 98112-5318 Ph: (206) 940-2165 |
NPI Number | 1376851097 |
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Provider Enumeration Date | 09/15/2010 |
Last Update Date | 08/17/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1376851097 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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