Healthcare Provider Details

I. General information

NPI: 1073720108
Provider Name (Legal Business Name): COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5929 EVERGREEN WAY
EVERETT WA
98203-6031
US

IV. Provider business mailing address

PO BOX 13060
EVERETT WA
98206-3060
US

V. Phone/Fax

Practice location:
  • Phone: 425-789-3700
  • Fax: 425-789-3754
Mailing address:
  • Phone: 425-789-3700
  • Fax: 425-789-3754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7034036
License Number StateWA

VIII. Authorized Official

Name: KENNETH M GREEN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 425-789-3700