Provider Demographics
NPI:1740891217
Name:AFFORDABLE MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:AFFORDABLE MEDICAL CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:CHIBOGU
Authorized Official - Last Name:EMEAGWALI
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP, PMHNP-BC
Authorized Official - Phone:301-412-7990
Mailing Address - Street 1:6475 NEW HAMPSHIRE AVE STE 430
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3277
Mailing Address - Country:US
Mailing Address - Phone:240-670-8305
Mailing Address - Fax:
Practice Address - Street 1:6475 NEW HAMPSHIRE AVE STE 430
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-3277
Practice Address - Country:US
Practice Address - Phone:240-670-8305
Practice Address - Fax:240-670-8306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-10
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC099825600Medicaid
MD422722100Medicaid