1518396845 NPI number — DRX WA URGENT CARE PROVIDERS PLLC

Table of content: (NPI 1518396845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518396845 NPI number — DRX WA URGENT CARE PROVIDERS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRX WA URGENT CARE PROVIDERS PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
IMMEDIATE CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518396845
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9000 HOLMAN RD NW
Provider Second Line Business Mailing Address:
SUITE A1
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98117-3418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-706-9001
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13131 NE 85TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98033-8092
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-702-8002
Provider Business Practice Location Address Fax Number:
425-702-8003
Provider Enumeration Date:
11/07/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SJOLSETH
Authorized Official First Name:
JEROMY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
480-818-3079

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)