Healthcare Provider Details

I. General information

NPI: 1558772087
Provider Name (Legal Business Name): PLATINUMCARE , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4061 MINNESOTA AVE NE
WASHINGTON DC
20019-3541
US

IV. Provider business mailing address

930 HOSTETTER RD
HANOVER PA
17331-7764
US

V. Phone/Fax

Practice location:
  • Phone: 717-451-7518
  • Fax: 717-646-8283
Mailing address:
  • Phone: 717-451-7518
  • Fax: 717-646-8283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. JACQUE MCLAUGHLIN EDWARDS
Title or Position: CEO
Credential:
Phone: 717-451-7518