MEDICARE: FEDERAL DETENTION CENTER SEATAC

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	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1558603431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FEDERAL DETENTION CENTER SEATAC

Provider Business Mailing Address
First Line	:	2425 S 200TH ST
Second Line	:
City	:	SEATAC
State	:	WA
Zip	:	98198-5202
Country	:	US
Telephone Number	:	206-870-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	2425 S 200TH ST
Second Line	:
City	:	SEATAC
State	:	WA
Zip	:	98198-5202
Country	:	US
Telephone Number	:	206-870-5700
Fax Number	:

Authorized Official
Title or Position	:	HEALTH SERVICES ADMINISTRATOR
Name	:	TITA ITURRALDE
Credential	:
Telephone Number	:	206-870-5740

Provider Enumeration Date	:	03/19/2013
Last Update Date	:	03/19/2013

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