Healthcare Provider Details

I. General information

NPI: 1033469473
Provider Name (Legal Business Name): SEA-MAR COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 100TH STREET NE
EVERETT WA
98208
US

IV. Provider business mailing address

PO BOX 34703
SEATTLE WA
98124-1703
US

V. Phone/Fax

Practice location:
  • Phone: 425-312-0202
  • Fax: 425-312-0209
Mailing address:
  • Phone: 206-764-3335
  • Fax: 206-764-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number600 537 278 1
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number600 537 278 1
License Number StateWA

VIII. Authorized Official

Name: ROGELIO RIOJAS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 206-788-3226