Healthcare Provider Details

I. General information

NPI: 1477582773
Provider Name (Legal Business Name): STAFFORD URGENT CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 GARRISONVILLE RD STE. 111
STAFFORD VA
22554-1573
US

IV. Provider business mailing address

PO BOX 729
GARRISONVILLE VA
22463-0729
US

V. Phone/Fax

Practice location:
  • Phone: 540-720-8000
  • Fax: 540-657-4366
Mailing address:
  • Phone: 540-657-9633
  • Fax: 540-657-5925

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: MR. KELL R. HOOVLER
Title or Position: PRESIDENT, CEO
Credential:
Phone: 540-657-9633