Provider Demographics
NPI:1669733515
Name:ACE MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:ACE MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:OVEISI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-770-2191
Mailing Address - Street 1:11520 ROCKVILLE PIKE STE J
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2761
Mailing Address - Country:US
Mailing Address - Phone:301-770-2191
Mailing Address - Fax:301-770-2193
Practice Address - Street 1:11520 ROCKVILLE PIKE STE J
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2761
Practice Address - Country:US
Practice Address - Phone:301-770-2191
Practice Address - Fax:301-770-2193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2013-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0067586261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care