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General NPI Number Information
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NPI Number | 1902027253
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Entity Type | Organization
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Legal Business Name | COUNTRY DOCTOR COMMUNITY CLINIC
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 01/26/2024
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Provider Practice Location Address
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Address Line | 2101 E YESLER WAY SUITE 150
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City | SEATTLE
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State | WA
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Zip | 98122-5959
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Country | US
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Telephone | 206-299-1900
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Fax | 206-299-1920
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Provider Business Mailing Address
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Address Line | 2101 E YESLER WAY SUITE 210
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City | SEATTLE
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State | WA
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Zip | 98122-5959
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Country | US
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Telephone | 206-299-1970
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Fax | 206-299-1920
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | MARIA SAUCEDO
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Credential |
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Telephone | 206-709-7112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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