Healthcare Provider Details

I. General information

NPI: 1902983109
Provider Name (Legal Business Name): INTERNATIONAL COMMUNITY HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 S OTHELLO ST 2ND FLOOR
SEATTLE WA
98118-3510
US

IV. Provider business mailing address

PO BOX 3007
SEATTLE WA
98114-3007
US

V. Phone/Fax

Practice location:
  • Phone: 206-788-3500
  • Fax: 206-788-3521
Mailing address:
  • Phone: 206-788-3600
  • Fax: 206-652-5216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number600436519
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: HERMES SHAHBAZIAN
Title or Position: CFO
Credential:
Phone: 206-788-3618