Provider Demographics
NPI:1306038989
Name:LORTON URGENT CARE, PLC
Entity Type:Organization
Organization Name:LORTON URGENT CARE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAKONNEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZELLEKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-339-5858
Mailing Address - Street 1:7740 GUNSTON PLAZA
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079
Mailing Address - Country:US
Mailing Address - Phone:703-728-8283
Mailing Address - Fax:
Practice Address - Street 1:7740 GUNSTON PLAZA
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079
Practice Address - Country:US
Practice Address - Phone:703-339-5858
Practice Address - Fax:703-339-5860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care