| Southgate Medical Clinic, P.s. | |
|
6044 Martin Luther King Jr Way S Ste 104 Seattle WA 98118-3179 | |
| (206) 723-9853 | |
| (206) 723-0849 |
| Full Name | Southgate Medical Clinic, P.s. |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 6044 Martin Luther King Jr Way S Ste 104, Seattle, Washington |
| Authorized Official Name and Position | Roberto A Velasco (MEDICAL PROVIDER/OWNER) |
| Authorized Official Contact | 2067239853 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| 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 | 1336254051 |
|---|---|
| Provider Enumeration Date | 08/20/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336254051 | NPI | - | NPPES |
| 7033046 | Medicaid | WA | |
| VE4004 | Other | WA | REGENCE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | MD00022120 (Washington) | Primary |
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