Provider Demographics
NPI:1104845361
Name:I C CARE CORPORATION
Entity Type:Organization
Organization Name:I C CARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:HERBERT
Authorized Official - Last Name:BONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-773-9700
Mailing Address - Street 1:1100 MERCANTILE LN
Mailing Address - Street 2:SUITE #135
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5380
Mailing Address - Country:US
Mailing Address - Phone:301-773-9700
Mailing Address - Fax:301-773-4900
Practice Address - Street 1:1100 MERCANTILE LN
Practice Address - Street 2:SUITE #135
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5380
Practice Address - Country:US
Practice Address - Phone:301-773-9700
Practice Address - Fax:301-773-4900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD31069174400000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD409341100Medicaid
MDC89226Medicare UPIN
MDG02026101Medicare ID - Type UnspecifiedCMS INDIVIDUAL NUMBER