Provider Demographics
NPI:1558785162
Name:MEDSTAR URGENT CARE LLC
Entity Type:Organization
Organization Name:MEDSTAR URGENT CARE LLC
Other - Org Name:MEDSTAR PROMPTCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KUCHKA-CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-772-6827
Mailing Address - Street 1:1321 RIVERSIDE PKWY
Mailing Address - Street 2:
Mailing Address - City:BELCAMP
Mailing Address - State:MD
Mailing Address - Zip Code:21017-1388
Mailing Address - Country:US
Mailing Address - Phone:410-297-2380
Mailing Address - Fax:410-297-2381
Practice Address - Street 1:1321 RIVERSIDE PKWY
Practice Address - Street 2:
Practice Address - City:BELCAMP
Practice Address - State:MD
Practice Address - Zip Code:21017-1388
Practice Address - Country:US
Practice Address - Phone:410-297-2380
Practice Address - Fax:410-297-2381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care