MEDICARE: SEA MAR COMMUNITY HEALTH CENTERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist
2	207Q00000X	Family Medicine Physician
3	207QS0010X	Sports Medicine (Family Medicine) Physician
4	207R00000X	Internal Medicine Physician
5	207RC0000X	Cardiovascular Disease Physician
6	207RE0101X	Endocrinology, Diabetes & Metabolism Physician
7	207RR0500X	Rheumatology Physician
8	208000000X	Pediatrics Physician
9	2080P0008X	Pediatric Neurodevelopmental Disabilities Physician
10	208100000X	Physical Medicine & Rehabilitation Physician
11	225100000X	Physical Therapist
12	225X00000X	Occupational Therapist
13	363A00000X	Physician Assistant
14	363L00000X	Nurse Practitioner
15	261QF0400X	Federally Qualified Health Center (FQHC)	600537278	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346398666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEA MAR COMMUNITY HEALTH CENTERS

Provider Business Mailing Address
First Line	:	PO BOX 34703
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98124-1703
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9650 15TH AVE SW STE 100
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98106-2576
Country	:	US
Telephone Number	:	206-965-1000
Fax Number	:	206-965-1001

Authorized Official
Title or Position	:	CREDENTIALING SUPERVISOR
Name	:	MARY BARTOLO
Credential	:
Telephone Number	:	206-763-5277

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	02/26/2025

Similar Medicare Providers

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Practice Location Address:

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1063447365 — DR. VANESSA FELICIANO M.D.
Practice Location Address:

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1952455404 — JULIAN C PEREZ MD
Practice Location Address:

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98106-2576

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1023154077 — SEA MAR COMMUNITY HEALTH CENTERS
Practice Location Address:

9650 15TH AVE SW
SEATTLE, WA
98106-2576

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1235251745 — CAROL JEAN NICHOLSON OTRL, CHT
Practice Location Address:

9650 15TH AVE SW
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98106-2576

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1710314943 — GEMY MARIA GEORGE M.D.
Practice Location Address:

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