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NPI 1790185759

NPI 1790185759 : SEA MAR COMMUNITY HEALTH CENTERS : CONCRETE, WA

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General NPI Number Information
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    NPI Number           |    1790185759
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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     |    08/27/2014
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    Last Update Date     |    02/26/2025
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Provider Practice Location Address
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    Address Line         |    7438 S D AVE STE A 
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    City                 |    CONCRETE
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    State                |    WA
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    Zip                  |    98237-9642
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    Country              |    US
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    Telephone            |    360-853-8183
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    Fax                  |    360-853-7211
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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        |    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 #2
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    Taxonomy Code        |    261QF0050X
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    Taxonomy Name        |    Non-Surgical Family Planning Clinic/Center
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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       |    
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    License Number State |    
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