Provider Demographics
NPI:1821155953
Name:SEATTLE-KING COUNTY DEPT. OF PUBLIC HEALTH
Entity Type:Organization
Organization Name:SEATTLE-KING COUNTY DEPT. OF PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGEMENT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:ARDELL
Authorized Official - Last Name:MOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-263-8807
Mailing Address - Street 1:13812 SE 51ST PL
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-3474
Mailing Address - Country:US
Mailing Address - Phone:425-562-8715
Mailing Address - Fax:
Practice Address - Street 1:13030 MILITARY RD S
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-3085
Practice Address - Country:US
Practice Address - Phone:206-242-0885
Practice Address - Fax:206-242-8558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-01
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI 00000539251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7600422Medicaid