Provider Demographics
NPI:1902175870
Name:MEDSTAR URGENT CARE LLC
Entity Type:Organization
Organization Name:MEDSTAR URGENT CARE LLC
Other - Org Name:MEDSTAR PROMPTCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-933-3017
Mailing Address - Street 1:6317 YORK RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-2359
Mailing Address - Country:US
Mailing Address - Phone:443-777-6890
Mailing Address - Fax:410-433-2015
Practice Address - Street 1:6317 YORK RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-2359
Practice Address - Country:US
Practice Address - Phone:443-777-6890
Practice Address - Fax:410-433-2015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-22
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care