| |
1930 Post Alley Seattle WA 98101-1015 | |
(206) 728-4143 | |
(206) 956-4018 |
Full Name | |
---|---|
Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 1930 Post Alley, Seattle, Washington |
Authorized Official Name and Position | Mark Lloyd Secord (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 2064616935 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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905 Spruce St Ste. 300 Seattle WA 98104-2474 Ph: (206) 461-6935 | 1930 Post Alley Seattle WA 98101-1015 Ph: (206) 728-4143 |
NPI Number | 1538225826 |
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Provider Enumeration Date | 12/29/2006 |
Last Update Date | 11/19/2010 |
Identifier | Type | State | Issuer |
---|---|---|---|
1538225826 | NPI | - | NPPES |
6001384186 | Other | STATE TAX ID | |
4914493 | Other | NCPDP | |
6008965 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | F000058312 (Washington) | Primary |
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