MEDICARE: RAINIER VALLEY COMMUNITY CLINIC

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	176B00000X	Midwife	MW60331598	WA

General Provider Information

NPI Number	:	1982089058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAINIER VALLEY COMMUNITY CLINIC

Provider Business Mailing Address
First Line	:	6061 MARTIN LUTHER KING JR WAY S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-3141
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6061 MARTIN LUTHER KING JR WAY S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-3141
Country	:	US
Telephone Number	:	425-231-4376
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KATHRYN ANN BARRON
Credential	:	LM CPM
Telephone Number	:	425-231-4376

Provider Enumeration Date	:	07/30/2015
Last Update Date	:	07/30/2015

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