Healthcare Provider Details

I. General information

NPI: 1528318896
Provider Name (Legal Business Name): MERCY URGENT CARE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2257 BEL PRE RD
SILVER SPRING MD
20906-2204
US

IV. Provider business mailing address

2257 BEL PRE RD
SILVER SPRING MD
20906-2204
US

V. Phone/Fax

Practice location:
  • Phone: 301-807-6957
  • Fax:
Mailing address:
  • Phone: 301-460-8000
  • Fax: 301-200-4610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR149483
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2011002215
License Number StateMD

VIII. Authorized Official

Name: PRUDENCE A MANCHO
Title or Position: OWNER
Credential: FNP-BC
Phone: 301-807-6957