Provider Demographics
NPI:1063826907
Name:COMMUNITY HEALTH & URGENT CARE CLINIC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH & URGENT CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERON
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMPHAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-801-0292
Mailing Address - Street 1:6401 NEW HAMPSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3201
Mailing Address - Country:US
Mailing Address - Phone:301-801-0292
Mailing Address - Fax:866-596-1084
Practice Address - Street 1:6401 NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-3201
Practice Address - Country:US
Practice Address - Phone:301-801-0292
Practice Address - Fax:866-596-1084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054991261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0054991OtherSTATE LICENSE