MEDICARE: SEATTLE-KING COUNTY DEPT OF PUBLIC HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2400X	Prison Health Clinic/Center
2	3336C0002X	Clinic Pharmacy	FO00003648	WA

General Provider Information

NPI Number	:	1386710739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEATTLE-KING COUNTY DEPT OF PUBLIC HEALTH

Provider Business Mailing Address
First Line	:	400 YESLER WAY STE 300
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98104-2615
Country	:	US
Telephone Number	:	206-205-5975
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 5TH AVE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98104-2332
Country	:	US
Telephone Number	:	206-296-1082
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE MANAGEMENT ADMINISTRATOR
Name	:	KEVIN ARDELL MOE
Credential	:
Telephone Number	:	206-263-8807

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	06/08/2026

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Directions to “SEATTLE-KING COUNTY DEPT OF PUBLIC HEALTH ” Practice Location

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