Provider Demographics
NPI:1346494234
Name:CRESCENT URGENT HEALTH CARE SERVICES, LLC
Entity Type:Organization
Organization Name:CRESCENT URGENT HEALTH CARE SERVICES, LLC
Other - Org Name:FAST TRACK URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:GHADYALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-605-8504
Mailing Address - Street 1:13428 NEW HAMPSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1264
Mailing Address - Country:US
Mailing Address - Phone:301-384-5010
Mailing Address - Fax:301-384-5020
Practice Address - Street 1:13428 NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1264
Practice Address - Country:US
Practice Address - Phone:301-384-5010
Practice Address - Fax:301-384-5020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD424047200Medicaid