Provider Demographics
NPI:1780040196
Name:URGE MEDICAL
Entity Type:Organization
Organization Name:URGE MEDICAL
Other - Org Name:DALEWOOD MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KULAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-680-5959
Mailing Address - Street 1:4158 DALE BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-2225
Mailing Address - Country:US
Mailing Address - Phone:703-680-5959
Mailing Address - Fax:703-730-1046
Practice Address - Street 1:4158 DALE BLVD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-2225
Practice Address - Country:US
Practice Address - Phone:703-680-5959
Practice Address - Fax:703-730-1046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101259313261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care