Healthcare Provider Details

I. General information

NPI: 1417529827
Provider Name (Legal Business Name): SEA - MAR COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 07/14/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 AIRPORT DR
BELLINGHAM WA
98226-8048
US

IV. Provider business mailing address

PO BOX 34703
SEATTLE WA
98124-1703
US

V. Phone/Fax

Practice location:
  • Phone: 360-734-5458
  • Fax:
Mailing address:
  • Phone: 360-734-5458
  • Fax: 360-734-5298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: OMAR M ESPINOSA
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 253-681-6610