COUNTRY DOCTOR COMMUNITY CLINIC (NPI# 1891343075) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891343075 |
| Entity Type | Organization |
| Organization Name | COUNTRY DOCTOR COMMUNITY CLINIC |
| Other Organization Name | COUNTRY DOCTOR HEP C CLINIC |
| Practice Address |
1621 S Jackson St Ste 201 Seattle WA 98144-2277 |
| Mailing Address |
2101 E Yesler Way Ste 210 Seattle WA 98122-5959 |
| Practice Telephone | 2062991900 |
| Practice Fax Number | 2062991900 |
| Mailing Telephone | 2062991937 |
| Mailing Fax Number | 2062991920 |
| Enumeration Date | 2019-08-30 |
| 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 |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | DEPARTMENT OF REVENUE | UBI601583685 | 01 |
| Other Name | Type Code |
|---|---|
| Country Doctor Hep C 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 |
| 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 |
1621 S JACKSON ST STE 201 |
| City | SEATTLE |
| State | WA |
| Zip Code | 98144-2277 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558975235 | Miranda Plummer | Counselor | 2122 S Jackson Street, Seattle, WA 98144 | 2020-09-01 |
| 1891337457 | Alyson Paris | Counselor | 2100 24th Ave S, Suite 260, Seattle, WA 98144 | 2019-10-15 |
| 1912558370 | Marco Antonio Medina Sotelo | Counselor | 113 23rd Avenue South, Seattle, WA 98144 | 2019-09-26 |
| 1952865909 | John Thomas Hogan | Counselor | 1600 S Lane, Seattle, WA 98144 | 2019-01-23 |
| 1134693856 | Kimo Martin | Peer Specialist | 1600 Lane St, Seattle, WA 98144 | 2019-01-15 |
| 1952875791 | Rainier Chiropractic Accident and Injury Ps | Massage Therapist | 2326 Rainier Ave S, Ste B, Seattle, WA 98144 | 2019-01-15 |
| 1174097083 | Seann M Combs | Counselor | 1600 S Lane St, Seattle, Wa 98144, Seattle, WA 98144 | 2019-01-14 |
| 1922571587 | Cristina Wirkala | Registered Nurse | Crisis Solutions Center, 1600 South Lane Street, Seattle, WA 98144 | 2019-01-07 |
| 1215405162 | Vickie Barron | Counselor | 3401 Rainier Ave S, Suite B, Seattle, WA 98144 | 2018-11-08 |
| 1164906509 | Julie Seddon Cabell | Counselor | Central Youth and Family Services, 1901 Mlk Jr Way S., Seattle, WA 98144 | 2018-09-21 |
| Find all providers in zip 98144 | ||||
| Taxonomy Code | 261QC1500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Community Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1356999288 | Country Doctor Community Clinic | Clinic/Center | 301 21st Ave E, Seattle, WA 98112-5318 | 2019-09-04 |
| 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.