1821002510 NPI number — PHYSICIANS IMMEDIATE CARE & MEDICAL CENTERS, P.S.

Table of content: (NPI 1821002510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821002510 NPI number — PHYSICIANS IMMEDIATE CARE & MEDICAL CENTERS, P.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIANS IMMEDIATE CARE & MEDICAL CENTERS, P.S.
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:
BESTMED
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:
1821002510
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5999
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97228-5999
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1215 GEORGE WASHINGTON WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99352-3411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-946-7646
Provider Business Practice Location Address Fax Number:
546-946-7666
Provider Enumeration Date:
07/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HAUSER
Authorized Official First Name:
ERICA
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
312-590-5372

Provider Taxonomy Codes

  • 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" .

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

  • Identifier: 0040370 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7049950 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".