Basic Information
| Provider Information | |||||||||
| NPI: | 1386208718 | ||||||||
| 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: | 2536816600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14508 NE 20TH AVE | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986866424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603979211 | ||||||||
| FaxNumber: | 3602604900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2019 | ||||||||
| LastUpdateDate: | 05/01/2019 | ||||||||
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| AuthorizedOfficialLastName: | WOODLAND | ||||||||
| AuthorizedOfficialFirstName: | RACHEL | ||||||||
| AuthorizedOfficialMiddleName: | BRIANNA | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 2536816600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.