Healthcare Provider Details

I. General information

NPI: 1508592114
Provider Name (Legal Business Name): INOVA UCC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 01/03/2023
Certification Date: 12/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 MAPLE AVE W
VIENNA VA
22180-5727
US

IV. Provider business mailing address

PO BOX 37174
BALTIMORE MD
21297-3174
US

V. Phone/Fax

Practice location:
  • Phone: 571-363-3539
  • Fax: 571-363-3540
Mailing address:
  • Phone: 703-289-8655
  • 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: ALICE POPE
Title or Position: CFO
Credential:
Phone: 571-472-8717