COUNTRY DOCTOR COMMUNITY CLINIC


Address: 2410 E Cherry St, Seattle, WA 98122-4832
Phone: 2062991900

COUNTRY DOCTOR COMMUNITY CLINIC (NPI# 1114540457) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1114540457
Entity Type Organization
Organization Name COUNTRY DOCTOR COMMUNITY CLINIC
Practice Address 2410 E Cherry St
Seattle
WA 98122-4832
Practice Telephone 2062991900
Practice Fax Number 2062991920
Mailing Telephone 2062991900
Mailing Fax Number 2062991920
Enumeration Date 2020-05-21
Last Update Date 2020-05-21
Authorized Official Name SUSANA TANTICO (DIRECTOR OF FINANCE)
Authorized Official Telephone 2062991937
Is Organization Subpart Y
Parent Organization Name COUNTRY DOCTOR COMMUNITY CLINIC

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207Q00000X Family Medicine Allopathic & Osteopathic Physicians

Other Provider/Organization Names

Other Name Type Code
Nova Wellness Center Doing Business As Name - Organization

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1891343075 Country Doctor Community Clinic Clinic/Center 1621 S Jackson St Ste 201, Seattle, WA 98144-2277 2019-08-30
1972623189 Country Doctor Community Clinic Case Management 2101 E Yesler Way Ste 210, Seattle, WA 98122-5959 2007-03-30
1356999288 Country Doctor Community Clinic Clinic/Center 301 21st Ave E, Seattle, WA 98112-5318 2019-09-04
1952883993 Country Doctor Community Clinic Clinic/Center 510 19th Ave E, Seattle, WA 98112-4007 2018-09-06
1497189773 Country Doctor Community Clinic Clinic/Center 550 16th Ave, Suite 100, Seattle, WA 98122-5699 2013-08-22
1881885549 Country Doctor Community Clinic Case Manager/Care Coordinator 2101 E Yesler Way, Suite 150, Seattle, WA 98122-5959 2007-08-07
1316138696 Country Doctor Community Clinic Case Manager/Care Coordinator 500 19th Ave E, Seattle, WA 98112-4007 2007-08-05
1952592230 Country Doctor Community Clinic Clinic/Center 500 19th Ave E, Seattle, WA 98112-4007 2007-08-05
1902027253 Country Doctor Community Clinic Pharmacy 2101 E Yesler Way, Suite 150, Seattle, WA 98122-5959 2007-05-02
1164642278 Country Doctor Community Clinic Family Medicine 2101 E Yesler Way, Suite 150, Seattle, WA 98122-5959 2007-04-30

Other Data Sources

Entity Type Entity Name Entity Address
Washington State Corporations COUNTRY DOCTOR COMMUNITY CLINIC 500 19th Ave E, Seattle, WA 98112-4007

Office Location

Street Address 2410 E CHERRY ST
City SEATTLE
State WA
Zip Code 98122-4832

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1053938506 Quality Counseling and Consultation Service LLC Counselor 1525 Harvard Ave #509, Seattle, WA 98122 2020-07-01
1912535626 Cesar Andrade Student in an Organized Health Care Education/Training Program 550 16th Avenue #400, Seattle, WA 98122 2020-03-29
1366089666 Peter Nguyen Pharmacy Technician 914 East Jefferson Street, Campion Hall, Seattle, WA 98122 2019-12-05
1356903140 Jason Dandino Specialist/Technologist 550 14th Avenue, Seattle, WA 98122 2019-07-02
1962066415 Seattle Colleges Local Education Agency (LEA) Mainstay At Seattle Central College, 1701 Broadway Ms Be3210, Seattle, WA 98122 2019-04-30
1538621412 Mitchell R Ornelas Student in an Organized Health Care Education/Training Program Swedish Family Medicine Residency Cherry Hill; 550 16th, Avenue #400, Seattle, WA 98122 2019-04-01
1003374265 Michael Russell Surgery 747 Broadway Heath Building 10th Floor, Seattle, WA 98122 2019-03-06
1639646821 Maritza E Cajiao Doula 747 Broadway, Seattle, Seattle, WA 98122 2018-10-25
1336616762 Suzanna M Lovin Social Worker 401 Broadway, 1st Floor, Seattle, WA 98122 2018-10-24
1184137770 Walter Franklin Krengel Jr. Orthopaedic Surgery 2000 1st Ave Suite 2201, Seattle, WA 98122 2017-11-06
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Taxonomy Information

Taxonomy Code 207Q00000X
Grouping Allopathic & Osteopathic Physicians
Classification Family Medicine

Taxonomy Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition]
- Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences.
- Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1407476500 Charles C. Falzon, Md, Pllc Family Medicine 24 Roy St # 359, Seattle, WA 98109-4018 2020-04-20
1669028635 Seattle World School Health Center Family Medicine 1700 E Union St, Seattle, WA 98122-4140 2019-08-14
1891350377 Kaiser Foundation Health Plan of Washington Family Medicine 210 9th Ave N, Seattle, WA 98109-5120 2019-05-09
1619436029 Galilea Medical Group, Pa Family Medicine 7527 42nd Ave Ne, Seattle, WA 98115-5101 2019-03-15
1912463670 Hillman City Medical Pllc Family Medicine 3828 S Graham St Suite A, Seattle, WA 98118 2019-02-18
1740769868 Oasis Medical Group, P.C. Family Medicine 301 Union St Unit 21502, Seattle, WA 98111-1623 2018-08-09
1316453608 William Curchin Family Medicine 904 7th Ave Fl 9, Seattle, WA 98104-1132 2017-12-21
1871020933 Seattle Sports & Regenerative Medicine Family Medicine 1000 Dexter Ave N Ste 300, Seattle, WA 98109-3579 2017-05-18
1790210847 Christina Choung Family Medicine 211 Pike St Fl 8, Seattle, WA 98101-2107 2017-04-26
1639601792 Edward Aradanas Elchico Family Medicine 720 8th Ave S Ste 2, Seattle, WA 98104-3032 2017-03-29
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Competitor

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City SEATTLE
Zip Code 98122

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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