Healthcare Provider Details

I. General information

NPI: 1679086086
Provider Name (Legal Business Name): SEA-MAR COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2017
Last Update Date: 11/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 W MAIN ST
ELMA WA
98541-9394
US

IV. Provider business mailing address

PO BOX 34703
SEATTLE WA
98124-1703
US

V. Phone/Fax

Practice location:
  • Phone: 360-861-8710
  • Fax: 360-861-8717
Mailing address:
  • Phone: 800-549-2493
  • Fax: 206-764-8094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JOLEE ANN ELIZABETH SANKEY
Title or Position: PROVIDER ENROLLMENT SPECIALIST
Credential:
Phone: 206-474-2001