Provider Demographics
NPI:1063399905
Name:PULLMAN URGENT CARE PLLC
Entity type:Organization
Organization Name:PULLMAN URGENT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:
Authorized Official - Last Name:MODAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-590-2602
Mailing Address - Street 1:1145 IDLERS REST RD
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-8124
Mailing Address - Country:US
Mailing Address - Phone:208-301-8255
Mailing Address - Fax:
Practice Address - Street 1:1490 NE NORTH FAIRWAY RD STE C
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-6077
Practice Address - Country:US
Practice Address - Phone:509-590-2602
Practice Address - Fax:509-508-4024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care