Provider Demographics
NPI:1558726141
Name:STATCARE GROUP II, PC
Entity Type:Organization
Organization Name:STATCARE GROUP II, PC
Other - Org Name:CHOICEONE URGENT CARE II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING & PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:ANGELA
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-296-7190
Mailing Address - Street 1:1400 FRONT AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5300
Mailing Address - Country:US
Mailing Address - Phone:410-296-7190
Mailing Address - Fax:410-296-0344
Practice Address - Street 1:2315 BEL AIR RD
Practice Address - Street 2:
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-2740
Practice Address - Country:US
Practice Address - Phone:410-296-7190
Practice Address - Fax:410-296-0344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-23
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0062737261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH0062737OtherLICENSE NUMBER