INTERNATIONAL COMMUNITY HEALTH SERVICES

Provider Demographics

• NPI: 1376659151
• Name: INTERNATIONAL COMMUNITY HEALTH SERVICES
• Entity Type: Organization
• Organization Name: INTERNATIONAL COMMUNITY HEALTH SERVICES
• Other - Org Name: INTERNATIONAL DISTRICT COMMUNITY HEALTH CENTER
• Other - Org Type: Former Legal Business Name
• Authorized Official - Title/Position: CFO
• Authorized Official - Prefix: MS
• Authorized Official - First Name: HERMES
• Authorized Official - Last Name: SHAHBAZIAN
• Authorized Official - Phone: 206-788-3618
• Mailing Address - Street 1: PO BOX 3007
• Mailing Address - City: SEATTLE
• Mailing Address - State: WA
• Mailing Address - Zip Code: 98114-3007
• Mailing Address - Country: US
• Mailing Address - Phone: 206-788-3600
• Mailing Address - Fax: 206-652-5216
• Practice Address - Street 1: 720 8TH AVE S
• Practice Address - City: SEATTLE
• Practice Address - State: WA
• Practice Address - Zip Code: 98104-3032
• Practice Address - Country: US
• Practice Address - Phone: 206-788-3700
• Practice Address - Fax: 206-788-3706
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-08-22
• Last Update Date: 2021-03-29

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	261QF0400X	Ambulatory Health Care Facilities	Clinic/Center	Federally Qualified Health Center (FQHC)	Group - Multi-Specialty
No	103T00000X	Behavioral Health & Social Service Providers	Psychologist		Group - Multi-Specialty
No	122300000X	Dental Providers	Dentist		Group - Multi-Specialty
No	152W00000X	Eye and Vision Services Providers	Optometrist		Group - Multi-Specialty
No	171100000X	Other Service Providers	Acupuncturist		Group - Multi-Specialty
No	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty
No	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine		Group - Multi-Specialty
No	208000000X	Allopathic & Osteopathic Physicians	Pediatrics		Group - Multi-Specialty
No	2084P0800X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Psychiatry	Group - Multi-Specialty
No	213ES0131X	Podiatric Medicine & Surgery Service Providers	Podiatrist	Foot Surgery	Group - Multi-Specialty
No	251B00000X	Agencies	Case Management		Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
WA	7034051	Medicaid
WA	G000151700	Medicare PIN
WA	501806	Medicare ID - Type Unspecified