Healthcare Provider Details

I. General information

NPI: 1740525872
Provider Name (Legal Business Name): DRX WA URGENT CARE PROVIDERS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2012
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15870 1ST AVE S SUITE 101
BURIEN WA
98148-1213
US

IV. Provider business mailing address

9000 HOLMAN RD NW SUITE A1
SEATTLE WA
98117-3418
US

V. Phone/Fax

Practice location:
  • Phone: 206-242-2501
  • Fax:
Mailing address:
  • Phone: 206-706-9001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHERYL MICKELSEN
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 208-292-0990