| Southgate Medical Clinic, P.s. | |
|
6044 Martin Luther King Jr Way S Ste 104 Seattle WA 98118-3179 | |
| (206) 723-9853 | |
| Not Available |
| Full Name | Southgate Medical Clinic, P.s. |
|---|---|
| Speciality | Clinic/Center |
| Location | 6044 Martin Luther King Jr Way S Ste 104, Seattle, Washington |
| Authorized Official Name and Position | Robert Alfiler Velasco (OWNER) |
| Authorized Official Contact | 2067239853 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southgate Medical Clinic, P.s. 6044 Martin Luther King Jr Way S Ste 104 Seattle WA 98118-3179 Ph: (206) 723-9853 | Southgate Medical Clinic, P.s. 6044 Martin Luther King Jr Way S Ste 104 Seattle WA 98118-3179 Ph: (206) 723-9853 |
| NPI Number | 1285751990 |
|---|---|
| Provider Enumeration Date | 03/26/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 6901824838 |
|---|---|
| Medicare Enrollment ID | O20051109000107 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285751990 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (Washington) | Primary |
| Provider Name | Robert A Velasco |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548376791 PECOS PAC ID: 4284652108 Enrollment ID: I20051109000090 |
| Provider Name | Bella Orbino |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710199427 PECOS PAC ID: 4082713946 Enrollment ID: I20070619000377 |
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