NPIMap

Organization Active NPI

Urgentcare NW-Astoria PC

  • Urgent Care Clinic/Center
  • Astoria, OR
National Provider Identifier
1902067010
Registry record updated Nov 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
License
1351854-3 Issued in OR
Legal business name
URGENTCARE NW-ASTORIA PC
Practice address
2120 Exchange St
Suite 111
Astoria, OR 97103-3366
Phone
(503) 325-0333
Fax
(503) 325-6333
NPI assigned
Jun 20, 2008
Last updated
Nov 6, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2015

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

Authorized official

Name
Mary A Klatt
Title
Chief Operations Officer
Phone
(503) 325-0333

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X
Urgent Care Clinic/Center 261QU0200X 1351854-3 OR Primary

Addresses

Primary practice location

2120 Exchange St
Suite 111
Astoria, OR 97103-3366

Mailing address

PO Box 96
Boring, OR 97009
Phone (503) 577-8410

Other identifiers 1

IdentifierTypeStateIssuer
246578MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20081217000721 OR Part B Supplier - Clinic/Group Practice 5799847232 Receives reassigned benefits from 4 practitioners
Practice locations: Astoria, OR
O20100310000131 OR Part A Provider - Rural Health Clinic 5799847232 Practice locations: Astoria, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902067010. Details of each certification follow.

Rural health clinic certification: CCN 383878

Legal name
URGENTCARE NW-ASTORIA PC
Doing business as
URGENTCARE NW - ASTORIA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 8, 2010
Last certification
Feb 28, 2024
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Feb 5, 2008 in OR
Enrollment address
2120 Exchange St #111
Astoria, OR 97103-3366

National Provider Directory

National Provider Directory

Locations

2158 Exchange St
Ste 111
Astoria, OR 97103
Phone (503) 325-0333

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Keith D Klatt Individual 5% Or Greater Direct Ownership Interest Jun 1, 2008
Corporate DirectorPresident/Cmo Jun 1, 2008
Mary Klatt Individual Corporate OfficerCoo Jun 1, 2010
W-2 Managing EmployeeCoo Jun 1, 2010
Kathleen Erven Individual W-2 Managing EmployeeExecutive Assistant Jan 1, 2019

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1213920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446768000000",
    "number": "1902067010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 96",
            "city": "BORING",
            "state": "OR",
            "postal_code": "97009",
            "telephone_number": "503-577-8410",
            "fax_number": "503-325-6333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2120 EXCHANGE ST",
            "address_2": "SUITE 111",
            "city": "ASTORIA",
            "state": "OR",
            "postal_code": "971033366",
            "telephone_number": "503-325-0333",
            "fax_number": "503-325-6333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "URGENTCARE NW-ASTORIA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-20",
        "last_updated": "2015-11-06",
        "status": "A",
        "authorized_official_last_name": "KLATT",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHIEF OPERATIONS OFFICER",
        "authorized_official_telephone_number": "503-325-0333"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "OR",
            "license": "1351854-3",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "246578",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Astoria, OR

Sources for this page

Verify at the official NPI Registry.