=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407325368
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEA MAR COMMUNITY HEALTH CENTERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2018
-----------------------------------------------------
Last Update Date | 02/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2203 OLD HWY 99 S
-----------------------------------------------------
City | MOUNT VERNON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98273-9009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-542-8810
-----------------------------------------------------
Fax | 360-542-8811
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 34703
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98124-1703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ROGELIO RIOJAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 206-763-5277
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------