=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770934929
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEA MAR COMMUNITY HEALTH CENTERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2016
-----------------------------------------------------
Last Update Date | 09/12/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19005 SE 34TH ST BUILDING 3
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98683-1450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-474-2001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8801 14TH AVE S
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98108-4809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-474-2001
-----------------------------------------------------
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 | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------