Healthcare Provider Details

I. General information

NPI: 1487251997
Provider Name (Legal Business Name): UMMS AMBULATORY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 DENTON PLZ
DENTON MD
21629-9501
US

IV. Provider business mailing address

900 ELKRIDGE LANDING RD FL 2
LINTHICUM MD
21090-2924
US

V. Phone/Fax

Practice location:
  • Phone: 443-606-2300
  • Fax: 443-606-2305
Mailing address:
  • Phone: 443-462-5010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SCOTT CONOVER
Title or Position: SENIOR VICE PRESIDENT, CLINICAL INT
Credential:
Phone: 410-337-1500