| Emurgent Care LLC | |
|
109 E Ellendale Ave Ste B Dallas OR 97338-1509 | |
| (503) 623-3199 | |
| (503) 623-3398 |
| Full Name | Emurgent Care LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 109 E Ellendale Ave Ste B, Dallas, Oregon |
| Authorized Official Name and Position | Crystal Hasina Kohistani (OWNER) |
| Authorized Official Contact | 6123067403 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Emurgent Care LLC 109 E Ellendale Ave Ste B Dallas OR 97338-1509 Ph: (503) 623-3199 | Emurgent Care LLC 109 E Ellendale Ave Ste B Dallas OR 97338-1509 Ph: (503) 623-3199 |
| NPI Number | 1265871123 |
|---|---|
| Provider Enumeration Date | 06/24/2013 |
| Last Update Date | 08/01/2022 |
| Certification Date | 08/01/2022 |
| Medicare PECOS PAC ID | 9830325075 |
|---|---|
| Medicare Enrollment ID | O20131119000265 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265871123 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | DO27917 (Oregon) | Secondary |
| 261QU0200X | Clinic/center - Urgent Care | (NU) | Primary |
| Provider Name | Marion Catherine Hull |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295775278 PECOS PAC ID: 8224007927 Enrollment ID: I20040929000750 |
| Provider Name | William R Fisher |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1427108455 PECOS PAC ID: 6002869104 Enrollment ID: I20050301000734 |
| Provider Name | Scott Johnson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1275719650 PECOS PAC ID: 3870678204 Enrollment ID: I20080310000642 |
| Provider Name | Daniel a Lowery |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1275623324 PECOS PAC ID: 6608035662 Enrollment ID: I20120309000646 |
| Provider Name | Emily G Atharinikrouh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639424104 PECOS PAC ID: 7517117419 Enrollment ID: I20121031000348 |
| Provider Name | Donna L Millan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780954214 PECOS PAC ID: 5698931715 Enrollment ID: I20130607000660 |
| Provider Name | Jeremy Gaylon Waldie |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1043546534 PECOS PAC ID: 0941341374 Enrollment ID: I20140422001307 |
| Provider Name | Crystal H Kohistani |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1275943821 PECOS PAC ID: 7113217076 Enrollment ID: I20160606000414 |
| Provider Name | Tyler J Witmer |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1831460922 PECOS PAC ID: 1557520194 Enrollment ID: I20171228002541 |
| Provider Name | Eugene O Vakhovsky |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1518637016 PECOS PAC ID: 7416346986 Enrollment ID: I20211123000751 |
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