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General NPI Number Information
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NPI Number | 1174961577
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Entity Type | Organization
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Legal Business Name | DYNAMIC MEDICAL URGENT CARE
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Dates
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Enumeration Date | 06/06/2013
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Last Update Date | 08/01/2013
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Provider Practice Location Address
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Address Line | 25 E WALNUT LN
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City | PHILADELPHIA
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State | PA
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Zip | 19144-2002
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Country | US
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Telephone | 267-335-3961
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Fax | 267-335-3702
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Provider Business Mailing Address
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Address Line | 25 E WALNUT LN
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City | PHILADELPHIA
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State | PA
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Zip | 19144-2002
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Country | US
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Telephone | 267-335-3961
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Fax | 267-335-3702
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Authorized Official
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Title or Position | OWNER
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Name | DR. HIGHLAND CAMPBELL
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Credential | M.D.
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Telephone | 412-728-0622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | MD422335
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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