Provider Demographics
NPI:1861242067
Name:FIRST RESPONSE DOCTORS CLINIC
Entity type:Organization
Organization Name:FIRST RESPONSE DOCTORS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER, BC-NP
Authorized Official - Prefix:DR
Authorized Official - First Name:LUM
Authorized Official - Middle Name:MERCY
Authorized Official - Last Name:MAXIMUANGU
Authorized Official - Suffix:
Authorized Official - Credentials:BC-NP
Authorized Official - Phone:240-604-2949
Mailing Address - Street 1:3214 BIRCHMEDE DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2302
Mailing Address - Country:US
Mailing Address - Phone:240-604-2949
Mailing Address - Fax:
Practice Address - Street 1:11303 AMHERST AVE STE 2
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-4600
Practice Address - Country:US
Practice Address - Phone:240-604-2949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty