Provider Demographics
NPI:1831838762
Name:MED 1ST WALKIN CLINIC AND PRIMARY CARE
Entity type:Organization
Organization Name:MED 1ST WALKIN CLINIC AND PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-268-4064
Mailing Address - Street 1:15 S CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3017
Mailing Address - Country:US
Mailing Address - Phone:240-362-7279
Mailing Address - Fax:240-362-7096
Practice Address - Street 1:15 S CENTRE ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3017
Practice Address - Country:US
Practice Address - Phone:240-362-7279
Practice Address - Fax:240-362-7096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-31
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty