MEDICARE: VALOR HEALTHCARE

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	261QP2300X	Primary Care Clinic/Center	LW6016081	WA

General Provider Information

NPI Number	:	1982138780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALOR HEALTHCARE

Provider Business Mailing Address
First Line	:	12360 LAKE CITY WAY NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-5447
Country	:	US
Telephone Number	:	206-384-4382
Fax Number	:	206-440-3137

Provider Business Practice Location Address
First Line	:	12360 LAKE CITY WAY NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-5447
Country	:	US
Telephone Number	:	206-384-4382
Fax Number	:	206-440-3137

Authorized Official
Title or Position	:	CLINIC OPERATIONS DIRECTOR
Name	:	MS. JESSICA WALCOTT
Credential	:
Telephone Number	:	206-384-4382

Provider Enumeration Date	:	04/18/2017
Last Update Date	:	04/18/2017

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