Healthcare Provider Details

I. General information

NPI: 1215265061
Provider Name (Legal Business Name): URBAN IMPACT COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2009
Last Update Date: 12/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7722 RAINIER AVE S
SEATTLE WA
98118-4139
US

IV. Provider business mailing address

7722 RAINIER AVE S
SEATTLE WA
98118-4139
US

V. Phone/Fax

Practice location:
  • Phone: 206-601-7200
  • Fax:
Mailing address:
  • Phone: 206-601-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MISS ELISABETH A KINGSLEY
Title or Position: CLINIC MANAGER
Credential:
Phone: 206-601-7200