Provider Demographics
NPI:1396178323
Name:DYNAMIC MEDICAL URGENT CARE OF LIMEKILN PIKE
Entity Type:Organization
Organization Name:DYNAMIC MEDICAL URGENT CARE OF LIMEKILN PIKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HIGHLAND
Authorized Official - Middle Name:R
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-335-3961
Mailing Address - Street 1:6101 LIMEKILN PIKE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-1423
Mailing Address - Country:US
Mailing Address - Phone:267-335-3961
Mailing Address - Fax:267-335-3702
Practice Address - Street 1:6101 LIMEKILN PIKE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-1423
Practice Address - Country:US
Practice Address - Phone:267-335-3961
Practice Address - Fax:267-335-3702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD422335261Q00000X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103692Medicare UPIN
PA077757Medicare PIN