Provider Demographics
NPI:1902067010
Name:URGENTCARE NW-ASTORIA PC
Entity type:Organization
Organization Name:URGENTCARE NW-ASTORIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KLATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-325-0333
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:BORING
Mailing Address - State:OR
Mailing Address - Zip Code:97009
Mailing Address - Country:US
Mailing Address - Phone:503-577-8410
Mailing Address - Fax:503-325-6333
Practice Address - Street 1:2120 EXCHANGE ST
Practice Address - Street 2:SUITE 111
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3366
Practice Address - Country:US
Practice Address - Phone:503-325-0333
Practice Address - Fax:503-325-6333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR1300X
OR1351854-3261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR246578Medicaid
OR6246630001Medicare NSC