Provider Demographics
NPI:1609950146
Name:IMMEDIATE CARE MEDICAL CENTER
Entity Type:Organization
Organization Name:IMMEDIATE CARE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:NWAOGBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-833-5000
Mailing Address - Street 1:11722 REISTERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-3302
Mailing Address - Country:US
Mailing Address - Phone:410-833-5000
Mailing Address - Fax:410-833-1433
Practice Address - Street 1:11722 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-3302
Practice Address - Country:US
Practice Address - Phone:410-833-5000
Practice Address - Fax:410-833-1433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS802Medicare PIN