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NPI Code Detail

MEDICARE: PUGET SOUND NEIGHBORHOOD HEALTH CENTERS

MEDICARE: PUGET SOUND NEIGHBORHOOD HEALTH CENTERS
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
1261QF0400XFederally Qualified Health Center (FQHC)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1528271749
Entity Type Code : Organization
Provider Name (Legal Business Name) : PUGET SOUND NEIGHBORHOOD HEALTH CENTERS
Provider Business Mailing Address
First Line : 905 SPRUCE ST
Second Line : STE. 300
City : SEATTLE
State : WA
Zip : 98104-2474
Country : US
Telephone Number : 206-461-6935
Fax Number : 206-461-8382
Provider Business Practice Location Address
First Line : 2600 SW THISTLE ST
Second Line :
City : SEATTLE
State : WA
Zip : 98126-3748
Country : US
Telephone Number : 206-938-1360
Fax Number : 206-935-6056
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MARK SECORD
Credential :
Telephone Number : 206-461-6935
Provider Enumeration Date : 05/07/2007
Last Update Date : 08/22/2020

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1568805083 — KIMBERLY PELTOLA LICSWA
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1073958294 — SUZANNE E PORTER RN
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1366813230 — JENNY LYNN GUTAMA KULAS LICSW
Practice Location Address:
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