Provider Demographics
NPI:1851763858
Name:ASSOCIATED MEDICAL CLINICS, INC.
Entity Type:Organization
Organization Name:ASSOCIATED MEDICAL CLINICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RENARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-728-6170
Mailing Address - Street 1:2404 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-1722
Mailing Address - Country:US
Mailing Address - Phone:410-728-6170
Mailing Address - Fax:
Practice Address - Street 1:2404 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-1722
Practice Address - Country:US
Practice Address - Phone:410-728-6170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01674111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty