Provider Demographics
NPI:1144474669
Name:ADVANCE URGENT CARE WALKIN CLINIC
Entity type:Organization
Organization Name:ADVANCE URGENT CARE WALKIN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAVOOS
Authorized Official - Middle Name:N
Authorized Official - Last Name:MESBAHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-257-4741
Mailing Address - Street 1:10535 CRESTWOOD DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-4416
Mailing Address - Country:US
Mailing Address - Phone:703-257-2070
Mailing Address - Fax:703-257-2072
Practice Address - Street 1:10535 CRESTWOOD DR
Practice Address - Street 2:SUITE101
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-4416
Practice Address - Country:US
Practice Address - Phone:703-257-2070
Practice Address - Fax:703-257-2072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1154424232Medicare PIN