Provider Demographics
NPI:1376075408
Name:TYSON URGENT CARE, LLC
Entity Type:Organization
Organization Name:TYSON URGENT CARE, LLC
Other - Org Name:EXPRESSCARE OF ASHBURN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:SHELIA
Authorized Official - Last Name:BAILEY-EL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-616-9027
Mailing Address - Street 1:8000 LOCH RAVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-8337
Mailing Address - Country:US
Mailing Address - Phone:410-616-9027
Mailing Address - Fax:410-616-9854
Practice Address - Street 1:20070 ASHBROOK COMMONS PLZ
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147
Practice Address - Country:US
Practice Address - Phone:410-616-9027
Practice Address - Fax:410-616-9854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-29
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101247765261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA283780Medicare PIN