Provider Demographics
NPI:1487838652
Name:VIRGINIA URGENT CARE LLC
Entity Type:Organization
Organization Name:VIRGINIA URGENT CARE LLC
Other - Org Name:NEXTCARE URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GORBATENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-705-8558
Mailing Address - Street 1:2145 E BASELINE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1546
Mailing Address - Country:US
Mailing Address - Phone:888-705-8558
Mailing Address - Fax:480-776-0025
Practice Address - Street 1:5825 PLANK RD
Practice Address - Street 2:SUITE 105
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-5207
Practice Address - Country:US
Practice Address - Phone:480-776-1600
Practice Address - Fax:480-776-0025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA261QU0200X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAGC1104Medicare PIN