COUNTRY DOCTOR COMMUNITY CLINIC (NPI# 1114540457) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114540457 |
| Entity Type | Organization |
| Organization Name | COUNTRY DOCTOR COMMUNITY CLINIC |
| Practice Address |
2410 E Cherry St Seattle WA 98122-4832 |
| Practice Telephone | 2062991900 |
| Practice Fax Number | 2062991920 |
| Mailing Telephone | 2062991900 |
| Mailing Fax Number | 2062991920 |
| Enumeration Date | 2020-05-21 |
| Last Update Date | 2020-05-21 |
| Authorized Official Name | SUSANA TANTICO (DIRECTOR OF FINANCE) |
| Authorized Official Telephone | 2062991937 |
| Is Organization Subpart | Y |
| Parent Organization Name | COUNTRY DOCTOR COMMUNITY CLINIC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Nova Wellness Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891343075 | Country Doctor Community Clinic | Clinic/Center | 1621 S Jackson St Ste 201, Seattle, WA 98144-2277 | 2019-08-30 |
| 1972623189 | Country Doctor Community Clinic | Case Management | 2101 E Yesler Way Ste 210, Seattle, WA 98122-5959 | 2007-03-30 |
| 1356999288 | Country Doctor Community Clinic | Clinic/Center | 301 21st Ave E, Seattle, WA 98112-5318 | 2019-09-04 |
| 1952883993 | Country Doctor Community Clinic | Clinic/Center | 510 19th Ave E, Seattle, WA 98112-4007 | 2018-09-06 |
| 1497189773 | Country Doctor Community Clinic | Clinic/Center | 550 16th Ave, Suite 100, Seattle, WA 98122-5699 | 2013-08-22 |
| 1881885549 | Country Doctor Community Clinic | Case Manager/Care Coordinator | 2101 E Yesler Way, Suite 150, Seattle, WA 98122-5959 | 2007-08-07 |
| 1316138696 | Country Doctor Community Clinic | Case Manager/Care Coordinator | 500 19th Ave E, Seattle, WA 98112-4007 | 2007-08-05 |
| 1952592230 | Country Doctor Community Clinic | Clinic/Center | 500 19th Ave E, Seattle, WA 98112-4007 | 2007-08-05 |
| 1902027253 | Country Doctor Community Clinic | Pharmacy | 2101 E Yesler Way, Suite 150, Seattle, WA 98122-5959 | 2007-05-02 |
| 1164642278 | Country Doctor Community Clinic | Family Medicine | 2101 E Yesler Way, Suite 150, Seattle, WA 98122-5959 | 2007-04-30 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | COUNTRY DOCTOR COMMUNITY CLINIC | 500 19th Ave E, Seattle, WA 98112-4007 |
| Street Address |
2410 E CHERRY ST |
| City | SEATTLE |
| State | WA |
| Zip Code | 98122-4832 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053938506 | Quality Counseling and Consultation Service LLC | Counselor | 1525 Harvard Ave #509, Seattle, WA 98122 | 2020-07-01 |
| 1912535626 | Cesar Andrade | Student in an Organized Health Care Education/Training Program | 550 16th Avenue #400, Seattle, WA 98122 | 2020-03-29 |
| 1366089666 | Peter Nguyen | Pharmacy Technician | 914 East Jefferson Street, Campion Hall, Seattle, WA 98122 | 2019-12-05 |
| 1356903140 | Jason Dandino | Specialist/Technologist | 550 14th Avenue, Seattle, WA 98122 | 2019-07-02 |
| 1962066415 | Seattle Colleges | Local Education Agency (LEA) | Mainstay At Seattle Central College, 1701 Broadway Ms Be3210, Seattle, WA 98122 | 2019-04-30 |
| 1538621412 | Mitchell R Ornelas | Student in an Organized Health Care Education/Training Program | Swedish Family Medicine Residency Cherry Hill; 550 16th, Avenue #400, Seattle, WA 98122 | 2019-04-01 |
| 1003374265 | Michael Russell | Surgery | 747 Broadway Heath Building 10th Floor, Seattle, WA 98122 | 2019-03-06 |
| 1639646821 | Maritza E Cajiao | Doula | 747 Broadway, Seattle, Seattle, WA 98122 | 2018-10-25 |
| 1336616762 | Suzanna M Lovin | Social Worker | 401 Broadway, 1st Floor, Seattle, WA 98122 | 2018-10-24 |
| 1184137770 | Walter Franklin Krengel Jr. | Orthopaedic Surgery | 2000 1st Ave Suite 2201, Seattle, WA 98122 | 2017-11-06 |
| Find all providers in zip 98122 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407476500 | Charles C. Falzon, Md, Pllc | Family Medicine | 24 Roy St # 359, Seattle, WA 98109-4018 | 2020-04-20 |
| 1669028635 | Seattle World School Health Center | Family Medicine | 1700 E Union St, Seattle, WA 98122-4140 | 2019-08-14 |
| 1891350377 | Kaiser Foundation Health Plan of Washington | Family Medicine | 210 9th Ave N, Seattle, WA 98109-5120 | 2019-05-09 |
| 1619436029 | Galilea Medical Group, Pa | Family Medicine | 7527 42nd Ave Ne, Seattle, WA 98115-5101 | 2019-03-15 |
| 1912463670 | Hillman City Medical Pllc | Family Medicine | 3828 S Graham St Suite A, Seattle, WA 98118 | 2019-02-18 |
| 1740769868 | Oasis Medical Group, P.C. | Family Medicine | 301 Union St Unit 21502, Seattle, WA 98111-1623 | 2018-08-09 |
| 1316453608 | William Curchin | Family Medicine | 904 7th Ave Fl 9, Seattle, WA 98104-1132 | 2017-12-21 |
| 1871020933 | Seattle Sports & Regenerative Medicine | Family Medicine | 1000 Dexter Ave N Ste 300, Seattle, WA 98109-3579 | 2017-05-18 |
| 1790210847 | Christina Choung | Family Medicine | 211 Pike St Fl 8, Seattle, WA 98101-2107 | 2017-04-26 |
| 1639601792 | Edward Aradanas Elchico | Family Medicine | 720 8th Ave S Ste 2, Seattle, WA 98104-3032 | 2017-03-29 |
| Find all providers in SEATTLE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.