Provider Demographics
NPI:1245858240
Name:QUICK CARE CLINIC USA. LLC
Entity type:Organization
Organization Name:QUICK CARE CLINIC USA. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:COLMAN
Authorized Official - Middle Name:O
Authorized Official - Last Name:EJERENWA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:301-536-0044
Mailing Address - Street 1:1807 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-3214
Mailing Address - Country:US
Mailing Address - Phone:301-536-0044
Mailing Address - Fax:
Practice Address - Street 1:1807 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-3214
Practice Address - Country:US
Practice Address - Phone:301-536-0044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care