Provider Demographics
NPI:1104394766
Name:ORTHO OIC ORTHOPAEDIC IMMEDIATE CARE, LLC
Entity Type:Organization
Organization Name:ORTHO OIC ORTHOPAEDIC IMMEDIATE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-566-6359
Mailing Address - Street 1:1701 CLARENDON BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-4800
Mailing Address - Country:US
Mailing Address - Phone:703-566-6359
Mailing Address - Fax:703-566-6360
Practice Address - Street 1:1701 CLARENDON BLVD STE 120
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-4800
Practice Address - Country:US
Practice Address - Phone:703-566-6359
Practice Address - Fax:703-566-6360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-12
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care