Provider Demographics
NPI:1912368101
Name:SPRINGFIELD PRIMARY AND WALK IN CLINIC INC
Entity Type:Organization
Organization Name:SPRINGFIELD PRIMARY AND WALK IN CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:YARED
Authorized Official - Middle Name:W
Authorized Official - Last Name:ENDAILALU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-646-4841
Mailing Address - Street 1:8316 TRAFORD LN
Mailing Address - Street 2:UNIT B
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1654
Mailing Address - Country:US
Mailing Address - Phone:703-646-4841
Mailing Address - Fax:
Practice Address - Street 1:8316 TRAFORD LN
Practice Address - Street 2:UNIT B
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1654
Practice Address - Country:US
Practice Address - Phone:703-646-4841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101254201261QH0100X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service