Provider Demographics
NPI:1265871123
Name:EMURGENT CARE LLC
Entity type:Organization
Organization Name:EMURGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:HASINA
Authorized Official - Last Name:KOHISTANI
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:612-306-7403
Mailing Address - Street 1:109 E ELLENDALE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-1509
Mailing Address - Country:US
Mailing Address - Phone:503-623-3199
Mailing Address - Fax:503-623-3398
Practice Address - Street 1:109 E ELLENDALE AVE STE B
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-1509
Practice Address - Country:US
Practice Address - Phone:503-623-3199
Practice Address - Fax:503-623-3398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-24
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO27917207Q00000X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty