Basic Information
| Provider Information | |||||||||
| NPI: | 1801372768 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SEA-MAR COMMUNITY HEALTH CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SEA MAR COMMUNITY HEALTH CENTERS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1040 S HENDERSON ST | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981084720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067635277 | ||||||||
| FaxNumber: | 2067883204 | ||||||||
| Practice Location | |||||||||
| Address1: | 9650 15TH AVE SW SUITE #100 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069574210 | ||||||||
| FaxNumber: | 2069574211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2018 | ||||||||
| LastUpdateDate: | 07/13/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | RIOJAS | ||||||||
| AuthorizedOfficialFirstName: | ROGELIO | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2067635277 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SEA-MAR COMMUNITY HEALTH CENTER | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | PHAR.CF.60780810 | WA | N | Suppliers | Pharmacy | Community/Retail Pharmacy | 333600000X | PHAR.CF.60780810 | WA | Y | Suppliers | Pharmacy |
No ID Information.