Provider Demographics
NPI:1144565219
Name:DRX WA URGENT CARE PROVIDERS, PLLC
Entity Type:Organization
Organization Name:DRX WA URGENT CARE PROVIDERS, PLLC
Other - Org Name:IMMEDIATE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JEROMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SJOLSETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-706-9001
Mailing Address - Street 1:9000 HOLMAN RD NW
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-3418
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:607 SE EVERETT MALL WAY
Practice Address - Street 2:SUITE 2
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-3248
Practice Address - Country:US
Practice Address - Phone:425-265-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-30
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8915133Medicare PIN