Healthcare Provider Details

I. General information

NPI: 1821002510
Provider Name (Legal Business Name): PHYSICIANS IMMEDIATE CARE & MEDICAL CENTERS, P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 GEORGE WASHINGTON WAY
RICHLAND WA
99352-3411
US

IV. Provider business mailing address

PO BOX 5999
PORTLAND OR
97228-5999
US

V. Phone/Fax

Practice location:
  • Phone: 509-946-7646
  • Fax: 546-946-7666
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ERICA HAUSER
Title or Position: CFO
Credential:
Phone: 312-590-5372