5E Community Clinic, LLC

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

WA-585 Issued in WA

Legal business name

5E COMMUNITY CLINIC, LLC

Practice address

5424 Ballard Ave NW
Suite 301
Seattle, WA 98107-4046

Phone

(206) 781-1371

Fax

(206) 781-1380

NPI assigned

Apr 3, 2014

Organization subpart

No

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

Authorized official

Name

Mark R Tibeau, EAMP, L.ACNPI 1700946498

Title

Sole Member

Phone

(206) 781-1371

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark Richard Tibeau, L.AC

  • Acupuncturist
  • Seattle, WA
  • NPI 1700946498
  NPD (past) Authorized official

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

{
    "created_epoch": "1396483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396483200000",
    "number": "1457779738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5424 BALLARD AVE NW",
            "address_2": "SUITE 301",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981074046",
            "telephone_number": "206-781-1371",
            "fax_number": "206-781-1380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5424 BALLARD AVE NW",
            "address_2": "SUITE 301",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981074046",
            "telephone_number": "206-781-1371",
            "fax_number": "206-781-1380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "5E COMMUNITY CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-03",
        "last_updated": "2014-04-03",
        "status": "A",
        "authorized_official_last_name": "TIBEAU",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "206-781-1371",
        "authorized_official_credential": "EAMP, L.AC"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Acupuncturist",
            "state": "WA",
            "license": "WA-585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Acupuncturist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2014; 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.