Provider Demographics
NPI:1760897359
Name:CARROLL URGENT CARE, LLC
Entity Type:Organization
Organization Name:CARROLL URGENT CARE, LLC
Other - Org Name:CARROLL HOSPITAL CENTER MY CARE NOW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELBLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-871-6861
Mailing Address - Street 1:1311 LONDONTOWN BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6454
Mailing Address - Country:US
Mailing Address - Phone:410-549-7222
Mailing Address - Fax:
Practice Address - Street 1:1311 LONDONTOWN BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6454
Practice Address - Country:US
Practice Address - Phone:410-549-7222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-23
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD364696Medicare PIN