Provider Demographics
NPI:1902261308
Name:STATCARE GROUP III, PC
Entity Type:Organization
Organization Name:STATCARE GROUP III, PC
Other - Org Name:CHOICEONE URGENT CARE III
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:T
Authorized Official - Last Name:BURGER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:410-296-7190
Mailing Address - Street 1:1400 FRONT AVENUE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093
Mailing Address - Country:US
Mailing Address - Phone:410-296-7190
Mailing Address - Fax:443-991-7768
Practice Address - Street 1:8 DENTON PLAZA
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629-9501
Practice Address - Country:US
Practice Address - Phone:443-606-2300
Practice Address - Fax:443-606-2305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QE0002X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH0062737OtherLICENSE NUMBER