=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083362875
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TUERK HOUSE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2022
-----------------------------------------------------
Last Update Date | 03/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 730 ASHBURTON ST
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21216-4703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-233-0684
-----------------------------------------------------
Fax | 410-233-8540
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 730 N ASHBURTON ST
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21216-4703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-233-0684
-----------------------------------------------------
Fax | 410-233-8540
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF COMPLIANCE
-----------------------------------------------------
Name | DR. FELICIA SAM
-----------------------------------------------------
Credential | DNP
-----------------------------------------------------
Telephone | 667-212-3631
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------