Provider Demographics
NPI:1114619384
Name:BEAVER URGENT CARE
Entity Type:Organization
Organization Name:BEAVER URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JONAS
Authorized Official - Middle Name:BRENDEN
Authorized Official - Last Name:MERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:360-640-5601
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:WA
Mailing Address - Zip Code:98305-0128
Mailing Address - Country:US
Mailing Address - Phone:360-640-5601
Mailing Address - Fax:
Practice Address - Street 1:200361 HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:WA
Practice Address - Zip Code:98305-9645
Practice Address - Country:US
Practice Address - Phone:360-640-5601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-24
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care