NPIMap

Organization Active NPI

Kittitas Valley Urgent Care PLLC

Doing business as Yakima Valley Urgent Care

  • Urgent Care Clinic/Center
  • Union Gap, WA
National Provider Identifier
1215567300
Registry record updated Jan 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
KITTITAS VALLEY URGENT CARE PLLC
Doing business as
Yakima Valley Urgent Care
Practice address
17 E Valley Mall Blvd Ste 2B
Union Gap, WA 98903-1652
Phone
(509) 367-8733
Fax
(509) 361-5015
NPI assigned
Jan 17, 2020
Last updated
Jan 17, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
KITTITAS VALLEY URGENT CARE,PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 17, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Paul David Wood
Title
Owner
Phone
(509) 899-6179

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X NU Primary

Addresses

Primary practice location

17 E Valley Mall Blvd Ste 2B
Union Gap, WA 98903-1652

Mailing address

17 E Valley Mall Blvd Ste 2B
Union Gap, WA 98903-1652
Phone (509) 367-8733

Other names 1

  • Yakima Valley Urgent Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200406002272 WA DME Supplier - Multi-Specialty - Physician 5092093542 Practice locations: Union Gap, WA

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2164950Yakima Valley Urgent Care17 E Valley Mall Blvd Ste 2B, Union Gap, WA 98903Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Kittitas Valley Urgent Care2 organizations share this tax ID, including this one
Part of
Kittitas Valley Urgent Care

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

17 E Valley Mall Blvd
Ste 2B
Union Gap, WA 98903
Phone (509) 367-8733

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1579219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579219200000",
    "number": "1215567300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 E VALLEY MALL BLVD STE 2B",
            "city": "UNION GAP",
            "state": "WA",
            "postal_code": "989031652",
            "telephone_number": "509-367-8733",
            "fax_number": "509-361-5015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 E VALLEY MALL BLVD STE 2B",
            "city": "UNION GAP",
            "state": "WA",
            "postal_code": "989031652",
            "telephone_number": "509-367-8733",
            "fax_number": "509-361-5015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KITTITAS VALLEY URGENT CARE PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KITTITAS VALLEY URGENT CARE,PLLC",
        "enumeration_date": "2020-01-17",
        "last_updated": "2020-01-17",
        "certification_date": "2020-01-17",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "509-899-6179"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Yakima Valley Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Union Gap, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.