Provider Demographics
NPI:1689864209
Name:SITARA MEDICAL INC PS
Entity Type:Organization
Organization Name:SITARA MEDICAL INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:HADI
Authorized Official - Last Name:JAFAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-802-2861
Mailing Address - Street 1:14340 SE 87TH PL
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98059-3429
Mailing Address - Country:US
Mailing Address - Phone:425-802-2861
Mailing Address - Fax:
Practice Address - Street 1:14841 179TH AVE SE STE 210
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1127
Practice Address - Country:US
Practice Address - Phone:425-802-2861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1120922Medicaid
WA1120922Medicaid