=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003446857
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRAN URGENT CARE & WELLNESS CENTERS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/21/2020
-----------------------------------------------------
Last Update Date | 10/05/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 710 SOUTH, 38TH STREET, SUITE B
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98418-6718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-719-7767
-----------------------------------------------------
Fax | 253-330-8646
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 710 SOUTH, 38TH STREET, SUITE B
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98418-6718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-719-7767
-----------------------------------------------------
Fax | 253-330-8646
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DAT TRAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 206-370-4748
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------