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General NPI Number Information
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NPI Number | 1700101797
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Entity Type | Organization
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Legal Business Name | SEA MAR COMMUNITY HEALTH CENTERS
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Dates
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Enumeration Date | 04/01/2010
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 669 WOODLAND SQUARE LOOP SE
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City | LACEY
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State | WA
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Zip | 98503-1038
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Country | US
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Telephone | 360-359-4840
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Fax | 360-359-4850
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Provider Business Mailing Address
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Address Line | PO BOX 34703
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City | SEATTLE
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State | WA
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Zip | 98124-1703
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT
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Name | MARY BARTOLO
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Credential |
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Telephone | 206-763-5277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 600 537 278 1
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License Number State | WA
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