Basic Information
| Provider Information | |||||||||
| NPI: | 1063079598 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEA MAR COMMUNITY HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 34703 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981241703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2536816601 | ||||||||
| FaxNumber: | 2536816641 | ||||||||
| Practice Location | |||||||||
| Address1: | 1813 SUMNER AVE | ||||||||
| Address2: | |||||||||
| City: | ABERDEEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985204600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608618710 | ||||||||
| FaxNumber: | 3608618717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2019 | ||||||||
| LastUpdateDate: | 05/22/2019 | ||||||||
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| AuthorizedOfficialLastName: | WOODLAND | ||||||||
| AuthorizedOfficialFirstName: | RACHEL | ||||||||
| AuthorizedOfficialMiddleName: | BRIANNA | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 2536816601 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | N | 193200000X MULTI-SPECIALTY GROUP | Dietary & Nutritional Service Providers | Dietitian, Registered | 171M00000X | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Case Manager/Care Coordinator | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.