COUNTRY DOCTOR COMMUNITY CLINIC (NPI# 1356999288) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356999288 |
| Entity Type | Organization |
| Organization Name | COUNTRY DOCTOR COMMUNITY CLINIC |
| Other Organization Name | COUNTRY DOCTOR SCHOOL BASED CLINIC |
| Practice Address |
301 21st Ave E Seattle WA 98112-5318 |
| Mailing Address |
2101 E Yesler Way Ste 210 Seattle WA 98122-5959 |
| Practice Telephone | 2062991937 |
| Practice Fax Number | 2062991920 |
| Mailing Telephone | 2062611641 |
| Enumeration Date | 2019-09-04 |
| Last Update Date | 2020-02-11 |
| 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 | 261QC1500X |
Clinic/Center Specialization: Community Health |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Country Doctor School Based Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114540457 | Country Doctor Community Clinic | Family Medicine | 2410 E Cherry St, Seattle, WA 98122-4832 | 2020-05-21 |
| 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 |
| 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 |
301 21ST AVE E |
| City | SEATTLE |
| State | WA |
| Zip Code | 98112-5318 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376851097 | Neighborcare Health | Clinic/Center | 301 21st Ave E, Seattle, WA 98112-5318 | 2010-09-15 |
| 1134766207 | Seneca Family of Agencies | Community/Behavioral Health | 301 21st Ave E, Seattle, WA 98112-5318 | 2019-12-07 |
| 1316420565 | Maegon Williams | Registered Nurse | 301 21st Ave E, Seattle, WA 98112-5318 | 2018-09-13 |
| 1447751326 | Katherine Courtney | Registered Nurse | 301 21st Ave E, Seattle, WA 98112-5318 | 2018-02-26 |
| 1174993687 | Sarah Doty | Social Worker | 301 21st Ave E, Seattle, WA 98112-5318 | 2015-09-28 |
| 1003154832 | Helene Margareta Mansfield | Registered Nurse | 301 21st Ave E, Seattle, WA 98112-5318 | 2013-01-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891254991 | Justin Jeng-young Fu | Student in an Organized Health Care Education/Training Program | 125 16 Th Ave E, Csb 545, Seattle, WA 98112 | 2019-03-18 |
| 1275015604 | Eyewear Gallery LLC | Optometrist | 3121 E. Madison St Ste 102, Seattle, WA 98112 | 2018-09-01 |
| 1336637081 | Oh Plastic and Reconstructive Surgery LLC | Plastic Surgery | 602 27th Ave E, Seattle, WA 98112 | 2018-04-27 |
| 1992228191 | John Joseph Folta | Chiropractor | 3121 E Madison St Ste 103a, Seattle, WA 98112 | 2017-07-19 |
| 1083161061 | Sheick Toure | Counselor | 122 16 Ave E, Seattle, WA 98112 | 2016-09-07 |
| 1457721805 | Jessica Donovan | Audiologist | 201 16th Ave E # Cmb, Seattle, WA 98112 | 2015-09-29 |
| 1952777427 | Ronald Berenson | Physiological Laboratory | 2032 41st Avenue, Seattle, WA 98112 | 2015-08-19 |
| 1225419005 | Adrienne Foley | Counselor | 1833 40th Ave. E., Seattle, WA 98112 | 2015-06-17 |
| 1952721771 | Ling Guo | Internal Medicine | Kaiser Permanente Central Hospital Building, 126 16th Ave E, Seattle, WA 98112 | 2014-04-19 |
| 1134548068 | Anne Gayman | Family Medicine | 125 16th Avenue East, Csb-540, Group Health Family Medicine Residency, Seattle, WA 98112 | 2014-04-08 |
| Find all providers in zip 98112 | ||||
| Taxonomy Code | 261QC1500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Community Health |
| Definition to come... |
| 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 |
| 1558424473 | Planned Parenthood of The Great Northwest and The Hawaiian Islands | Clinic/Center | 2001 East Madison Street, Seattle, WA 98178 | 2006-12-19 |
| 1578593562 | Neighborcare Health | Clinic/Center | 1200 12th Ave S Ste 901, Seattle, WA 98144-2712 | 2006-07-04 |
| 1982150074 | Rite Aid | Clinic/Center | 13201 Aurora Ave N, Seattle, WA 98133-7584 | 2016-08-29 |
| 1932654548 | Bartell Drugs | Clinic/Center | 4025 Delridge Way Sw, Suite 400, Seattle, WA 98106-1249 | 2016-08-24 |
| 1497189773 | Country Doctor Community Clinic | Clinic/Center | 550 16th Ave, Suite 100, Seattle, WA 98122-5699 | 2013-08-22 |
| 1093044307 | Sea-mar Community Health Center | Clinic/Center | 9650 15th Ave Sw, #100, Seattle, WA 98106-2820 | 2009-12-15 |
| 1306171897 | Chong Fang | Clinic/Center | 3223 1st Ave S, Suite C, Seattle, WA 98134 | 2009-10-16 |
| 1669633681 | Sea-mar Community Health Center | Clinic/Center | 8915 14th Ave S, 3rd Floor, Seattle, WA 98108-4813 | 2008-06-23 |
| 1295892586 | Seattle-king County Dept of Public Health | Clinic/Center | 401 5th Ave, Suite 1200, Seattle, WA 98104-2333 | 2007-01-03 |
| 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.