NPIMap

Organization Active NPI

Country Doctor Community Clinic

Doing business as Country Doctor Community Clinic Pharmacy

  • Clinic Pharmacy
  • Seattle, WA
National Provider Identifier
1639390982
Registry record updated Jan 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
CF00004729 Issued in WA
Legal business name
COUNTRY DOCTOR COMMUNITY CLINIC
Doing business as
Country Doctor Community Clinic Pharmacy
Practice address
510 19TH Ave E
Seattle, WA 98112-4095
Phone
(206) 709-7116
Fax
(206) 299-1608
NPI assigned
May 2, 2007
Last updated
Jan 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2024

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

Authorized official

Name
Maria Saucedo
Title
Credentialing Specialist
Phone
(206) 709-7112

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X CF00004729 WA Primary

Addresses

Primary practice location

510 19TH Ave E
Seattle, WA 98112-4095

Mailing address

510 19TH Ave E
Seattle, WA 98112-4095
Phone (206) 709-7116

Other identifiers 1

IdentifierTypeStateIssuer
PHAR.CF.61403411OtherWALICENSE NUMBER

Other names 1

  • Country Doctor Community Clinic Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Country Doctor 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.

Locations

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

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706227200000",
    "number": "1639390982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 19TH AVE E",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981124095",
            "telephone_number": "206-709-7116",
            "fax_number": "206-299-1920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 19TH AVE E",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981124095",
            "telephone_number": "206-709-7116",
            "fax_number": "206-299-1608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY DOCTOR COMMUNITY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-02",
        "last_updated": "2024-01-26",
        "certification_date": "2024-01-26",
        "status": "A",
        "authorized_official_last_name": "SAUCEDO",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "206-709-7112"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "WA",
            "license": "CF00004729",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "PHAR.CF.61403411",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Country Doctor Community Clinic Pharmacy",
            "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 Jan 26, 2024; 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.