Provider Demographics
NPI:1275993495
Name:MAINLINE URGENT CARE MEDICAL GROUP P.C
Entity Type:Organization
Organization Name:MAINLINE URGENT CARE MEDICAL GROUP P.C
Other - Org Name:EXPRESSCARE OF RED LION, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:NATHANIEL
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-420-6970
Mailing Address - Street 1:1505 E CHURCHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4742
Mailing Address - Country:US
Mailing Address - Phone:410-420-6970
Mailing Address - Fax:
Practice Address - Street 1:3193 CAPE HORN RD
Practice Address - Street 2:
Practice Address - City:RED LION
Practice Address - State:PA
Practice Address - Zip Code:17356-8810
Practice Address - Country:US
Practice Address - Phone:610-482-4949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD442240261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102867981-0002Medicaid
PA102867981-0002Medicaid
PA539809Medicare PIN