Healthcare Provider Details

I. General information

NPI: 1912213372
Provider Name (Legal Business Name): SKAGIT FAMILY HEALTH CLINIC LLC COWAN SETH P MBR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 S 3RD ST
MOUNT VERNON WA
98273-4324
US

IV. Provider business mailing address

916 S 3RD ST
MOUNT VERNON WA
98273-4324
US

V. Phone/Fax

Practice location:
  • Phone: 360-336-9997
  • Fax: 360-336-5655
Mailing address:
  • Phone: 360-336-9997
  • Fax: 360-336-5655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License NumberCBC.FS.60172666
License Number StateWA

VIII. Authorized Official

Name: MICHELLE ANN ANTONICH
Title or Position: DIRECTOR
Credential:
Phone: 360-336-9997