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	207Q00000X	Family Medicine Physician
2	261QF0400X	Federally Qualified Health Center (FQHC)	6005372781	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	:	1689721011
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	:	6884 HANNEGAN RD
Second Line	:
City	:	EVERSON
State	:	WA
Zip	:	98247-9637
Country	:	US
Telephone Number	:	360-354-0766
Fax Number	:	360-354-6939

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT
Name	:	MARY BARTOLO
Credential	:
Telephone Number	:	206-788-3224

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

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1386476026 — MR. GABE RAPHAEL WORTMAN ARNP
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Practice Location Address:

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Practice Location Address:

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Directions to “SEA MAR COMMUNITY HEALTH CENTERS ” Practice Location

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