NPIMap

Organization Active NPI

International Community Health Services

  • Family Medicine Physician
  • Seattle, WA
National Provider Identifier
1104940733
Registry record updated Dec 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
INTERNATIONAL COMMUNITY HEALTH SERVICES
Practice address
3815 S Othello St
2ND Floor
Seattle, WA 98118-3510
Phone
(206) 788-3500
Fax
(206) 788-3521
NPI assigned
Mar 19, 2007
Organization subpart
Yes
Parent organization
INTERNATIONAL COMMUNITY HEALTH SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 20, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Peggy Phung
Title
Assistant Finance Manager
Phone
(206) 788-3605

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X WA Primary

Addresses

Primary practice location

3815 S Othello St
2ND Floor
Seattle, WA 98118-3510

Mailing address

PO Box 24911
Seattle, WA 98124-0911
Phone (206) 788-3600

Other identifiers 1

IdentifierTypeStateIssuer
7900012MedicaidWA

Other names 1

  • Holly Park Medical & Dental Clinic Other name

National Provider Directory

National Provider Directory
Tax ID family
International Community Health Services33 organizations share this tax ID, including this one
Part of
International Community Health Services

Other organizations with this tax ID 31

Organizations that report the same tax identification number in the National Provider Directory.

View all 31

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198108800000",
    "number": "1104940733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24911",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981240911",
            "telephone_number": "206-788-3600",
            "fax_number": "206-652-5216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3815 S OTHELLO ST",
            "address_2": "2ND FLOOR",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981183510",
            "telephone_number": "206-788-3500",
            "fax_number": "206-788-3521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNATIONAL COMMUNITY HEALTH SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTERNATIONAL COMMUNITY HEALTH SERVICES",
        "enumeration_date": "2007-03-19",
        "last_updated": "2007-12-20",
        "status": "A",
        "authorized_official_last_name": "PHUNG",
        "authorized_official_first_name": "PEGGY",
        "authorized_official_title_or_position": "ASSISTANT FINANCE MANAGER",
        "authorized_official_telephone_number": "206-788-3605"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7900012",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Holly Park Medical & Dental Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.