Provider Demographics
NPI:1659061059
Name:LUCIELLE URGENT CARE, INC
Entity Type:Organization
Organization Name:LUCIELLE URGENT CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUCIELLE
Authorized Official - Middle Name:TAKANG
Authorized Official - Last Name:AYUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-350-1131
Mailing Address - Street 1:903 1/2 YORK RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2514
Mailing Address - Country:US
Mailing Address - Phone:240-350-1131
Mailing Address - Fax:240-556-0535
Practice Address - Street 1:903 1/2 YORK RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2514
Practice Address - Country:US
Practice Address - Phone:240-350-1131
Practice Address - Fax:240-556-0535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care