Provider Demographics
NPI:1033500079
Name:MEDGEN URGENT CARE VIRGINIA LLC
Entity Type:Organization
Organization Name:MEDGEN URGENT CARE VIRGINIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-258-1627
Mailing Address - Street 1:6841 ELM ST
Mailing Address - Street 2:#916
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-0916
Mailing Address - Country:US
Mailing Address - Phone:202-258-1627
Mailing Address - Fax:844-213-1098
Practice Address - Street 1:3117 DUKE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-4518
Practice Address - Country:US
Practice Address - Phone:703-751-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDGEN URGENT CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-12
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care