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1200 12th Ave S Ste 401 Seattle WA 98144 | |
| (206) 548-5850 | |
| (206) 328-4034 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1200 12th Ave S Ste 401, Seattle, Washington |
| Authorized Official Name and Position | Michael Erikson (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 2064616935 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 3835 Seattle WA 98124-3835 Ph: (206) 548-3100 | 1200 12th Ave S Ste 401 Seattle WA 98144 Ph: (206) 548-5850 |
| NPI Number | 1982052874 |
|---|---|
| Provider Enumeration Date | 06/01/2016 |
| Last Update Date | 08/20/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982052874 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 600138418 (Washington) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 600138418 (Washington) | Primary |
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