Provider Demographics
NPI:1871035527
Name:YOUR DOCTORS URGENT CARE & PAIN RELIEF CENTER,LLC
Entity Type:Organization
Organization Name:YOUR DOCTORS URGENT CARE & PAIN RELIEF CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:OLAYINKA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLASIMBO
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:301-396-4444
Mailing Address - Street 1:177 SAINT PATRICKS DR
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-5532
Mailing Address - Country:US
Mailing Address - Phone:301-396-4444
Mailing Address - Fax:301-396-4449
Practice Address - Street 1:177 SAINT PATRICKS DR
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-5532
Practice Address - Country:US
Practice Address - Phone:301-396-4444
Practice Address - Fax:301-396-4449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-12
Last Update Date:2016-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0040209261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service