Provider Demographics
NPI:1083179154
Name:SEA - MAR COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:SEA - MAR COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JOLEE
Authorized Official - Middle Name:ANN ELIZABETH
Authorized Official - Last Name:SANKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-474-2001
Mailing Address - Street 1:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:206-764-3335
Mailing Address - Fax:206-764-0489
Practice Address - Street 1:9635 DES MOINES MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-5061
Practice Address - Country:US
Practice Address - Phone:206-474-2001
Practice Address - Fax:206-764-8005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty