Provider Demographics
NPI:1134275522
Name:MARTINSVILLE URGENT CARE LLC
Entity type:Organization
Organization Name:MARTINSVILLE URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:BAPTIST
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-634-0010
Mailing Address - Street 1:1044 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-3232
Mailing Address - Country:US
Mailing Address - Phone:276-634-0010
Mailing Address - Fax:276-632-0120
Practice Address - Street 1:1044 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-3232
Practice Address - Country:US
Practice Address - Phone:276-634-0010
Practice Address - Fax:276-632-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101224431261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
5969180001Medicare NSC