Provider Demographics
NPI:1114393048
Name:UNIVERSITY OF MARYLAND CHARLES REGIONAL URGENT CARE, LLC
Entity Type:Organization
Organization Name:UNIVERSITY OF MARYLAND CHARLES REGIONAL URGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:BOAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-609-5163
Mailing Address - Street 1:500 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-5931
Mailing Address - Country:US
Mailing Address - Phone:301-609-4699
Mailing Address - Fax:
Practice Address - Street 1:500 CHARLES ST
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-5931
Practice Address - Country:US
Practice Address - Phone:301-609-4699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF MARYLAND CHARLES REGIONAL HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care