Provider Demographics
NPI:1740600246
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:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DHIRENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:224-766-9400
Mailing Address - Street 1:9000 HOLMAN RD NW
Mailing Address - Street 2:SUITE A1
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-3418
Mailing Address - Country:US
Mailing Address - Phone:206-706-9001
Mailing Address - Fax:206-706-9002
Practice Address - Street 1:15500 1ST AVE S
Practice Address - Street 2:SUITE 106
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-1052
Practice Address - Country:US
Practice Address - Phone:206-706-9001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
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
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8915134Medicare Oscar/Certification