Provider Demographics
NPI:1508875584
Name:URGENT MEDICAL CARE OF LAKE-RIDGE,INC.
Entity Type:Organization
Organization Name:URGENT MEDICAL CARE OF LAKE-RIDGE,INC.
Other - Org Name:DBA MY URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RANA MAHESHINDER
Authorized Official - Middle Name:JIT
Authorized Official - Last Name:SANDHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MSC
Authorized Official - Phone:703-497-1234
Mailing Address - Street 1:14527 JEFFERSON DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-2817
Mailing Address - Country:US
Mailing Address - Phone:703-497-1234
Mailing Address - Fax:703-499-9988
Practice Address - Street 1:7598 TELEGRAPH ROAD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-3829
Practice Address - Country:US
Practice Address - Phone:703-778-0400
Practice Address - Fax:703-778-0444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
VA0101040696305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Single Specialty