Healthcare Provider Details

I. General information

NPI: 1669047098
Provider Name (Legal Business Name): SEATTLE INDIAN HEALTH BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 05/27/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12736 33RD AVE NE # 200
SEATTLE WA
98125-4504
US

IV. Provider business mailing address

611 12TH AVE S
SEATTLE WA
98144-2007
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGELA LAFONTAINE
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 206-324-4036