Healthcare Provider Details

I. General information

NPI: 1063399905
Provider Name (Legal Business Name): PULLMAN URGENT CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 NE STADIUM WAY
PULLMAN WA
99163-3825
US

IV. Provider business mailing address

1145 IDLERS REST RD
MOSCOW ID
83843-8124
US

V. Phone/Fax

Practice location:
  • Phone: 509-590-2602
  • Fax: 509-508-4024
Mailing address:
  • Phone: 208-301-8255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. GUILLERMO MODAD
Title or Position: OWNER
Credential: MD
Phone: 509-590-2602