Healthcare Provider Details

I. General information

NPI: 1164642278
Provider Name (Legal Business Name): SEATTLE ROOTS COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 06/05/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 E YESLER WAY SUITE 150
SEATTLE WA
98122-5959
US

IV. Provider business mailing address

2101 E YESLER WAY SUITE 210
SEATTLE WA
98122-5959
US

V. Phone/Fax

Practice location:
  • Phone: 206-299-1900
  • Fax: 206-299-1906
Mailing address:
  • Phone: 206-709-7112
  • Fax: 206-299-1920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: ANGIE TREPTOW
Title or Position: INTERIM FINANCE DIRECTOR
Credential:
Phone: 206-299-1937