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  7. NPI Record 1578610911

SEA MAR COMMUNITY HEALTH CENTERS
Complete NPI Record 1578610911
Clinic/Center - Federally Qualified Health Center (FQHC) in Marysville, WA

NPI Status: Active since January 05, 2007

Contact Information

9710 STATE AVE
MARYSVILLE, WA
ZIP 98270
Phone: (360) 653-1742
Fax: (360) 657-3095

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider Other Organization Name
  6. Provider Other Organization Name Type Code
  7. Provider First Line Business Mailing Address
  8. Provider Business Mailing Address City Name
  9. Provider Business Mailing Address State Name
  10. Provider Business Mailing Address Postal Code
  11. Provider Business Mailing Address Country Code If outside U S
  12. Provider First Line Business Practice Location Address
  13. Provider Business Practice Location Address City Name
  14. Provider Business Practice Location Address State Name
  15. Provider Business Practice Location Address Postal Code
  16. Provider Business Practice Location Address Country Code If outside U S
  17. Provider Business Practice Location Address Telephone Number
  18. Provider Business Practice Location Address Fax Number
  19. Provider Enumeration Date
  20. Last Update Date
  21. Authorized Official Last Name
  22. Authorized Official First Name
  23. Authorized Official Middle Name
  24. Authorized Official Title or Position
  25. Authorized Official Telephone Number
  26. Healthcare Provider Taxonomy Code 1
  27. Healthcare Provider Primary Taxonomy Switch 1
  28. Healthcare Provider Taxonomy Code 2
  29. Healthcare Provider Primary Taxonomy Switch 2
  30. Healthcare Provider Taxonomy Code 3
  31. Healthcare Provider Primary Taxonomy Switch 3
  32. Healthcare Provider Taxonomy Code 4
  33. Healthcare Provider Primary Taxonomy Switch 4
  34. Healthcare Provider Taxonomy Code 5
  35. Healthcare Provider Primary Taxonomy Switch 5
  36. Healthcare Provider Taxonomy Code 6
  37. Healthcare Provider Primary Taxonomy Switch 6
  38. Healthcare Provider Taxonomy Code 7
  39. Healthcare Provider Primary Taxonomy Switch 7
  40. Healthcare Provider Taxonomy Code 8
  41. Healthcare Provider Primary Taxonomy Switch 8
  42. Healthcare Provider Taxonomy Code 9
  43. Healthcare Provider Primary Taxonomy Switch 9
  44. Healthcare Provider Taxonomy Code 10
  45. Healthcare Provider Primary Taxonomy Switch 10
  46. Healthcare Provider Taxonomy Code 11
  47. Healthcare Provider Primary Taxonomy Switch 11
  48. Healthcare Provider Taxonomy Code 12
  49. Healthcare Provider Primary Taxonomy Switch 12
  50. Healthcare Provider Taxonomy Code 13
  51. Provider License Number 13
  52. Provider License Number State Code 13
  53. Healthcare Provider Primary Taxonomy Switch 13
  54. Healthcare Provider Taxonomy Code 14
  55. Healthcare Provider Primary Taxonomy Switch 14
  56. Healthcare Provider Taxonomy Code 15
  57. Healthcare Provider Primary Taxonomy Switch 15
  58. Other Provider Identifier 1
  59. Other Provider Identifier Type Code 1
  60. Other Provider Identifier State 1
  61. Other Provider Identifier 2
  62. Other Provider Identifier Type Code 2
  63. Other Provider Identifier State 2
  64. Is Organization Subpart
  65. Healthcare Provider Taxonomy Group 1
  66. Healthcare Provider Taxonomy Group 2
  67. Healthcare Provider Taxonomy Group 3
  68. Healthcare Provider Taxonomy Group 4
  69. Healthcare Provider Taxonomy Group 5
  70. Healthcare Provider Taxonomy Group 6
  71. Healthcare Provider Taxonomy Group 7
  72. Healthcare Provider Taxonomy Group 8
  73. Healthcare Provider Taxonomy Group 9
  74. Healthcare Provider Taxonomy Group 10
  75. Healthcare Provider Taxonomy Group 11
  76. Healthcare Provider Taxonomy Group 12
  77. Healthcare Provider Taxonomy Group 14
  78. Healthcare Provider Taxonomy Group 15
  79. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1578610911. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1578610911
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Other Organization Name: UNAVAIL
Other name by which the organization provider is or has been known.
Provider Other Organization Name Type Code: 6
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address: PO BOX 34703
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: SEATTLE
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: WA
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 981241703
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The telephone number associated with the location address of the provider being identified.
Provider First Line Business Practice Location Address: 9710 STATE AVE
The fax number associated with the location address of the provider being identified.
Provider Business Practice Location Address City Name: MARYSVILLE
The date the provider was assigned a unique identifier (assigned an NPI).
Provider Business Practice Location Address State Name: WA
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 982702232
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 3606531742
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 3606573095
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 1/5/2007
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 2/26/2025
The date that a record was last updated or changed.
Authorized Official Last Name: BARTOLO
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: MARY
The first name of the authorized official.
Authorized Official Middle Name: E
The middle name of the authorized official.
Authorized Official Title or Position: EXECUTIVE VICE PRESIDENT
The title or position of the authorized official.
Authorized Official Telephone Number: 2067635277
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 133V00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: N
Healthcare Provider Taxonomy Code 2: 207Q00000X
Healthcare Provider Primary Taxonomy Switch 2: N
Healthcare Provider Taxonomy Code 3: 207QA0000X
Healthcare Provider Primary Taxonomy Switch 3: N
Healthcare Provider Taxonomy Code 4: 207QA0401X
Healthcare Provider Primary Taxonomy Switch 4: N
Healthcare Provider Taxonomy Code 5: 207QG0300X
Healthcare Provider Primary Taxonomy Switch 5: N
Healthcare Provider Taxonomy Code 6: 207QS0010X
Healthcare Provider Primary Taxonomy Switch 6: N
Healthcare Provider Taxonomy Code 7: 208000000X
Healthcare Provider Primary Taxonomy Switch 7: N
Healthcare Provider Taxonomy Code 8: 2080A0000X
Healthcare Provider Primary Taxonomy Switch 8: N
Healthcare Provider Taxonomy Code 9: 2080N0001X
Healthcare Provider Primary Taxonomy Switch 9: N
Healthcare Provider Taxonomy Code 10: 2080P0201X
Healthcare Provider Primary Taxonomy Switch 10: N
Healthcare Provider Taxonomy Code 11: 2080P0203X
Healthcare Provider Primary Taxonomy Switch 11: N
Healthcare Provider Taxonomy Code 12: 2080P0208X
Healthcare Provider Primary Taxonomy Switch 12: N
Healthcare Provider Taxonomy Code 13: 261QF0400X
Provider License Number 13: 600537278
Provider License Number State Code 13: WA
Healthcare Provider Primary Taxonomy Switch 13: Y
Healthcare Provider Taxonomy Code 14: 363A00000X
Healthcare Provider Primary Taxonomy Switch 14: N
Healthcare Provider Taxonomy Code 15: 363L00000X
Healthcare Provider Primary Taxonomy Switch 15: N
Other Provider Identifier 1: 7034192
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: WA
Other Provider Identifier 2: 1013748
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: WA
Is Organization Subpart: N
Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 2: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 3: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 4: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 5: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 6: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 7: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 8: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 9: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 10: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 11: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 12: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 14: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 15: 193200000X MULTI-SPECIALTY GROUP
NPI Certification Date: 2/26/2025