NPI Code Details Logo

NPI 1760080154

NPI 1760080154 : SEA MAR COMMUNITY HEALTH CENTERS : VASHON, WA

=====================================================
General NPI Number Information
=====================================================
    NPI Number           |    1760080154
-----------------------------------------------------
    Entity Type          |    Organization 
-----------------------------------------------------
    Legal Business Name  |    SEA MAR COMMUNITY HEALTH CENTERS 
-----------------------------------------------------

=====================================================
Dates
=====================================================
    Enumeration Date     |    10/16/2020
-----------------------------------------------------
    Last Update Date     |    02/26/2025
-----------------------------------------------------

=====================================================
Provider Practice Location Address
=====================================================
    Address Line         |    10030 SW 210TH ST 
-----------------------------------------------------
    City                 |    VASHON
-----------------------------------------------------
    State                |    WA
-----------------------------------------------------
    Zip                  |    98070-6584
-----------------------------------------------------
    Country              |    US
-----------------------------------------------------
    Telephone            |    206-463-3671
-----------------------------------------------------
    Fax                  |    206-463-3613
-----------------------------------------------------

=====================================================
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    |    EXECUTIVE VICE PRESIDENT
-----------------------------------------------------
    Name                 |     MARY  BARTOLO 
-----------------------------------------------------
    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        |    101YA0400X
-----------------------------------------------------
    Taxonomy Name        |    Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
    Taxonomy Code        |    207Q00000X
-----------------------------------------------------
    Taxonomy Name        |    Family Medicine Physician
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
    Taxonomy Code        |    207QA0000X
-----------------------------------------------------
    Taxonomy Name        |    Adolescent Medicine (Family Medicine) Physician
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
    Taxonomy Code        |    207QA0505X
-----------------------------------------------------
    Taxonomy Name        |    Adult Medicine Physician
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
    Taxonomy Code        |    207QS0010X
-----------------------------------------------------
    Taxonomy Name        |    Sports Medicine (Family Medicine) Physician
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
    Taxonomy Code        |    207R00000X
-----------------------------------------------------
    Taxonomy Name        |    Internal Medicine Physician
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #8
-----------------------------------------------------
    Taxonomy Code        |    207RC0000X
-----------------------------------------------------
    Taxonomy Name        |    Cardiovascular Disease Physician
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #9
-----------------------------------------------------
    Taxonomy Code        |    207RE0101X
-----------------------------------------------------
    Taxonomy Name        |    Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #10
-----------------------------------------------------
    Taxonomy Code        |    207RG0300X
-----------------------------------------------------
    Taxonomy Name        |    Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #11
-----------------------------------------------------
    Taxonomy Code        |    207RN0300X
-----------------------------------------------------
    Taxonomy Name        |    Nephrology Physician
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #12
-----------------------------------------------------
    Taxonomy Code        |    207V00000X
-----------------------------------------------------
    Taxonomy Name        |    Obstetrics & Gynecology Physician
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #13
-----------------------------------------------------
    Taxonomy Code        |    2084P0800X
-----------------------------------------------------
    Taxonomy Name        |    Psychiatry Physician
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #14
-----------------------------------------------------
    Taxonomy Code        |    2084P0804X
-----------------------------------------------------
    Taxonomy Name        |    Child & Adolescent Psychiatry Physician
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #15
-----------------------------------------------------
    Taxonomy Code        |    261QF0400X
-----------------------------------------------------
    Taxonomy Name        |    Federally Qualified Health Center (FQHC)
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------



                        

Copyright © 2007-2025 Data Labs Health. All rights reserved.