Healthcare Provider Details

I. General information

NPI: 1275993495
Provider Name (Legal Business Name): MAINLINE URGENT CARE MEDICAL GROUP P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2016
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3193 CAPE HORN RD
RED LION PA
17356-8810
US

IV. Provider business mailing address

1505 E CHURCHVILLE RD
BEL AIR MD
21014-4742
US

V. Phone/Fax

Practice location:
  • Phone: 610-482-4949
  • Fax:
Mailing address:
  • Phone: 410-420-6970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberMD442240
License Number StatePA

VIII. Authorized Official

Name: DR. MAURICE NATHANIEL REID
Title or Position: CEO/MD
Credential: M.D.
Phone: 410-420-6970