Healthcare Provider Details

I. General information

NPI: 1437297488
Provider Name (Legal Business Name): SEATTLE INDIAN HEALTH BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 12TH AVE S
SEATTLE WA
98144-1910
US

IV. Provider business mailing address

611 12TH AVE S
SEATTLE WA
98144-1910
US

V. Phone/Fax

Practice location:
  • Phone: 206-324-9360
  • Fax: 206-324-8910
Mailing address:
  • Phone: 206-324-9360
  • Fax: 206-324-8910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number600440936
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. ESTHER LUCERO
Title or Position: EXECUTIVE DIRECTOR
Credential: MPP
Phone: 206-324-9360