Provider Demographics
NPI:1215567300
Name:KITTITAS VALLEY URGENT CARE PLLC
Entity Type:Organization
Organization Name:KITTITAS VALLEY URGENT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-899-6179
Mailing Address - Street 1:17 E VALLEY MALL BLVD STE 2B
Mailing Address - Street 2:
Mailing Address - City:UNION GAP
Mailing Address - State:WA
Mailing Address - Zip Code:98903-1652
Mailing Address - Country:US
Mailing Address - Phone:509-367-8733
Mailing Address - Fax:509-361-5015
Practice Address - Street 1:17 E VALLEY MALL BLVD STE 2B
Practice Address - Street 2:
Practice Address - City:UNION GAP
Practice Address - State:WA
Practice Address - Zip Code:98903-1652
Practice Address - Country:US
Practice Address - Phone:509-367-8733
Practice Address - Fax:509-361-5015
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KITTITAS VALLEY URGENT CARE,PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care