Provider Demographics
NPI:1093741076
Name:DEER PARK URGENT CARE PLLC
Entity Type:Organization
Organization Name:DEER PARK URGENT CARE PLLC
Other - Org Name:DEER PARK URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRACTICIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-276-5005
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-0340
Mailing Address - Country:US
Mailing Address - Phone:509-262-9000
Mailing Address - Fax:509-276-3034
Practice Address - Street 1:702 SOUTH PARK
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006
Practice Address - Country:US
Practice Address - Phone:509-262-9000
Practice Address - Fax:509-276-3034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7135437Medicaid
WAG8863183Medicare PIN