Provider Demographics
NPI: | 1922624642 |
---|---|
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: | 225 176TH ST S |
Practice Address - Street 2: | |
Practice Address - City: | SPANAWAY |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98387-9201 |
Practice Address - Country: | US |
Practice Address - Phone: | 253-240-2130 |
Practice Address - Fax: | 253-240-2133 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-06-18 |
Last Update Date: | 2023-08-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
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 | 133N00000X | Dietary & Nutritional Service Providers | Nutritionist | Group - Multi-Specialty | |
No | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Multi-Specialty | |
No | 133VN1004X | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Pediatric | Group - Multi-Specialty |
No | 133VN1005X | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Renal | Group - Multi-Specialty |
No | 133VN1006X | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Metabolic | Group - Multi-Specialty |
No | 163W00000X | Nursing Service Providers | Registered Nurse | Group - Multi-Specialty | |
No | 174H00000X | Other Service Providers | Health Educator | Group - Multi-Specialty | |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 2081P0004X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Spinal Cord Injury Medicine | Group - Multi-Specialty |
No | 2081S0010X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine | Group - Multi-Specialty |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WA | 2164523 | Medicaid |