Provider Demographics
NPI:1255583258
Name:URGENTCARE NW - FAIRVIEW PC
Entity type:Organization
Organization Name:URGENTCARE NW - FAIRVIEW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING LEAD
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JARCHOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-666-5050
Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-0167
Mailing Address - Country:US
Mailing Address - Phone:503-666-5050
Mailing Address - Fax:503-666-7410
Practice Address - Street 1:22262 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-8553
Practice Address - Country:US
Practice Address - Phone:503-666-5050
Practice Address - Fax:503-666-7410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR146286Medicare PIN
OR6245760001Medicare NSC