Healthcare Provider Details

I. General information

NPI: 1467869693
Provider Name (Legal Business Name): SEA MAR COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 S HENDERSON ST
SEATTLE WA
98108-4720
US

IV. Provider business mailing address

PO BOX 34703
SEATTLE WA
98124-1703
US

V. Phone/Fax

Practice location:
  • Phone: 206-764-0502
  • Fax:
Mailing address:
  • Phone: 206-764-3335
  • Fax: 206-764-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number600537278
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number600537278
License Number StateWA

VIII. Authorized Official

Name: ROGELIO RIOJAS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 206-788-3226