Provider Demographics
NPI:1073966156
Name:SHENANDOAH FAMILY URGENT CARE, LLC
Entity Type:Organization
Organization Name:SHENANDOAH FAMILY URGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:
Authorized Official - Last Name:ATHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-380-8225
Mailing Address - Street 1:1912 SEPTEMBER CT
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-3313
Mailing Address - Country:US
Mailing Address - Phone:540-825-9182
Mailing Address - Fax:
Practice Address - Street 1:15237 CREATIVITY DR
Practice Address - Street 2:SUITE 103
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-2504
Practice Address - Country:US
Practice Address - Phone:540-380-8225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHENANDOAH FAMILY CARE MANAGEMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care