Healthcare Provider Details

I. General information

NPI: 1366655953
Provider Name (Legal Business Name): INTERNATIONAL COMMUNITY HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 8TH AVE S STE 100
SEATTLE WA
98104-3032
US

IV. Provider business mailing address

PO BOX 24911
SEATTLE WA
98124-0911
US

V. Phone/Fax

Practice location:
  • Phone: 206-788-3500
  • Fax: 206-788-3706
Mailing address:
  • Phone: 206-788-3600
  • Fax: 206-652-5216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PEGGY PHUNG
Title or Position: ASSISTANT FINANCE MANAGER
Credential:
Phone: 206-788-3600