Organization
COUNTRY DOCTOR COMMUNITY CLINIC
Active
Other names
Country Doctor Clinic-Maternal Support Services
Organization subpart
No
Provider details
NPI number
Authorized official
SHONNIE EVANS (QI MANAGER)
(206) 299-1984
Entity
Organization
Contact information
Practice address
500 19TH AVE E, SEATTLE, WA 98112-4007
(206) 299-1600
(206) 299-1608
Mailing address
500 19TH AVE E, SEATTLE, WA 98112-4007
(206) 299-1600
(206) 299-1608
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7402852
—
WA
Enumeration date
08/05/2007
Last updated
06/25/2008
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