Provider Demographics
NPI:1215561998
Name:PACIFIC NORTHWEST URGENT CARE LLC
Entity Type:Organization
Organization Name:PACIFIC NORTHWEST URGENT CARE LLC
Other - Org Name:PACIFIC URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALOYSIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:FOBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-953-2391
Mailing Address - Street 1:6344 SE 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-5330
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 OCEAN BEACH HWY STE 110
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4171
Practice Address - Country:US
Practice Address - Phone:360-648-8860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-02
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty