EHS URGENT CARE LLC

Provider Demographics

• NPI: 1518023134
• Name: EHS URGENT CARE LLC
• Entity Type: Organization
• Organization Name: EHS URGENT CARE LLC
• Authorized Official - Title/Position: EHS CHIEF FINANCIAL OFFICER
• Authorized Official - Prefix: MR
• Authorized Official - First Name: LAURANCE
• Authorized Official - Middle Name: J
• Authorized Official - Last Name: LAUX
• Authorized Official - Phone: 509-473-7968
• Mailing Address - Street 1: PO BOX 94367
• Mailing Address - City: SEATTLE
• Mailing Address - State: WA
• Mailing Address - Zip Code: 98124-6667
• Mailing Address - Country: US
• Mailing Address - Phone: 509-922-9254
• Mailing Address - Fax: 509-922-7294
• Practice Address - Street 1: 2713 N ARGONNE RD
• Practice Address - City: SPOKANE
• Practice Address - State: WA
• Practice Address - Zip Code: 99212-2239
• Practice Address - Country: US
• Practice Address - Phone: 509-922-9254
• Practice Address - Fax: 509-922-7294
• EIN: <UNAVAIL>
• Is Organization Subpart?: Yes
• Parent Organization LBN: EMPIRE HEALTH SERVICES
• Parent Organization TIN: <UNAVAIL>
• Enumeration Date: 2006-12-28
• Last Update Date: 2007-12-13

Provider Licenses

State	License ID	Taxonomies
WA	MD00040823	207Q00000X
WA	MD00028821	207Q00000X
WA	MD00014304	207Q00000X
WA	MD00020779	207Q00000X
WA	MD00043817	207Q00000X
WA	MD00037317	207Q00000X
WA	MD00046086	207Q00000X
WA	MD00014839	207Q00000X
WA	MD00028904	207Q00000X
WA	MD00030462	207R00000X
WA	MD00037060	207R00000X
WA	MD00015819	208D00000X
WA	MD00028442	208D00000X
WA	OP00001551	208D00000X
WA	MD00015869	208D00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty
No	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine		Group - Multi-Specialty
No	208D00000X	Allopathic & Osteopathic Physicians	General Practice		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
WA	A07883	Medicare UPIN
WA	I29452	Medicare UPIN
WA	G65419	Medicare UPIN
WA	G66766	Medicare UPIN
WA	E07056	Medicare UPIN
WA	F63420	Medicare UPIN
WA	A07880	Medicare UPIN
WA	A07925	Medicare UPIN
WA	E65730	Medicare UPIN
WA	G34234	Medicare UPIN
WA	A07171	Medicare UPIN
WA	D51387	Medicare UPIN
WA	E17448	Medicare UPIN
WA	H01983	Medicare UPIN
WA	H09366	Medicare UPIN
WA	F73021	Medicare UPIN