NPIMap

Organization Active NPI

Country Doctor Community Clinic

Doing business as Country Doctor Clinic-Maternal Support Services

  • Case Manager/Care Coordinator
  • Seattle, WA
National Provider Identifier
1316138696
Registry record updated Jun 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Manager/Care CoordinatorTaxonomy code 171M00000X
Legal business name
COUNTRY DOCTOR COMMUNITY CLINIC
Doing business as
Country Doctor Clinic-Maternal Support Services
Practice address
500 19TH Ave E
Seattle, WA 98112-4007
Phone
(206) 299-1600
Fax
(206) 299-1608
NPI assigned
Aug 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2008

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

Authorized official

Name
Shonnie Evans
Title
Qi Manager
Phone
(206) 299-1984

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care CoordinatorGroup: 193400000X SINGLE SPECIALTY GROUP 171M00000X Primary

Addresses

Primary practice location

500 19TH Ave E
Seattle, WA 98112-4007

Mailing address

500 19TH Ave E
Seattle, WA 98112-4007
Phone (206) 299-1600

Other identifiers 1

IdentifierTypeStateIssuer
7402852MedicaidWA

Other names 1

  • Country Doctor Clinic-Maternal Support Services Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Country Doctor Comm Clinic9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

NPI Registry JSON

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

{
    "created_epoch": "1186272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1316138696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 19TH AVE E",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981124007",
            "telephone_number": "206-299-1600",
            "fax_number": "206-299-1608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 19TH AVE E",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981124007",
            "telephone_number": "206-299-1600",
            "fax_number": "206-299-1608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY DOCTOR COMMUNITY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-05",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "SHONNIE",
        "authorized_official_title_or_position": "QI MANAGER",
        "authorized_official_telephone_number": "206-299-1984"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7402852",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Country Doctor Clinic-Maternal Support Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 25, 2008; 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.