Holly Park Medical & Dental Clinic
LBN: International Community Health Services
Holly Park Medical & Dental Clinic is an health care organization with primary practice located at 3815 S Othello St 2Nd Floor, Seattle WA 98118-3510. The organization recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Agencies / Case Management, Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC). Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC) is the primary health care specialty.
International Community Health Services can be contacted via phone (206) 788-3500, or through Shahbazian, Hermes via phone (206) 788-3618.
Contact Information
Primary practice address
3815 S Othello St 2Nd Floor
Seattle WA 98118-3510
Phone: (206) 788-3500
Fax: (206) 788-3521
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 600436519 | Washington |
| Agencies / Case Management | 251B00000X | ||
| Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC) | 261QF0400X |
Profile Details
| NPI number | 1902983109 |
|---|---|
| LBN Legal business name | International Community Health Services |
| DBA Doing business as | Holly Park Medical & Dental Clinic |
| Authorized official | Shahbazian, Hermes |
| Entity | Organization |
| Organization subpart 1 | Yes |
| Enumeration date | Nov 1st, 2006 |
| Last updated | Apr 7th, 2021 - about 3 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1902983109 | NPPES |
| Washington | MEDICAID | 7125289 |
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