Provider Demographics
NPI:1235778812
Name:SEATTLE INDIAN HEALTH BOARD
Entity Type:Organization
Organization Name:SEATTLE INDIAN HEALTH BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:YAZZIE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:206-324-9360
Mailing Address - Street 1:611 12TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2007
Mailing Address - Country:US
Mailing Address - Phone:206-324-9360
Mailing Address - Fax:206-899-1682
Practice Address - Street 1:124 2ND AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-5168
Practice Address - Country:US
Practice Address - Phone:206-292-6214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEATTLE INDIAN HEALTH BOARD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-31
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty