MEDICARE: KITTITAS VALLEY URGENT CARE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1578926770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KITTITAS VALLEY URGENT CARE PLLC

Provider Business Mailing Address
First Line	:	702 E MOUNTAIN VIEW AVE STE 1
Second Line	:
City	:	ELLENSBURG
State	:	WA
Zip	:	98926-3862
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	702 E MOUNTAIN VIEW AVE STE 1
Second Line	:
City	:	ELLENSBURG
State	:	WA
Zip	:	98926-3862
Country	:	US
Telephone Number	:	509-968-5273
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID WOOD
Credential	:
Telephone Number	:	509-899-6179

Provider Enumeration Date	:	04/04/2016
Last Update Date	:	07/23/2024

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