Provider Demographics
NPI:1659777928
Name:MEDSTAR URGENT CARE, LLC
Entity Type:Organization
Organization Name:MEDSTAR URGENT CARE, LLC
Other - Org Name:MEDSTAR PROMPTCARE - ALEXANDRIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-230-7820
Mailing Address - Street 1:3610 KING STREET
Mailing Address - Street 2:SUITE D
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-1921
Mailing Address - Country:US
Mailing Address - Phone:703-845-2815
Mailing Address - Fax:703-845-2815
Practice Address - Street 1:3610 KING ST
Practice Address - Street 2:SUITE D
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1908
Practice Address - Country:US
Practice Address - Phone:703-845-2815
Practice Address - Fax:703-845-2815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care