Provider Demographics
NPI:1740906551
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:PA-C
Authorized Official - Phone:509-899-6179
Mailing Address - Street 1:1006 S 64TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-2090
Mailing Address - Country:US
Mailing Address - Phone:509-955-9248
Mailing Address - Fax:509-955-8248
Practice Address - Street 1:1006 S 64TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-2090
Practice Address - Country:US
Practice Address - Phone:509-955-9248
Practice Address - Fax:509-955-8248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care