Provider Demographics
NPI:1508049008
Name:SEA-MAR COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:SEA-MAR COMMUNITY HEALTH CENTER
Other - Org Name:SEA-MAR COMMUNITY HEALTH CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-763-5277
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:
Mailing Address - Fax:
Practice Address - Street 1:17707 W MAIN ST FL 1
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1967
Practice Address - Country:US
Practice Address - Phone:360-282-3885
Practice Address - Fax:360-512-2026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6 H80CS00445-05-03261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2000118Medicaid
WA7144322Medicaid