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General NPI Number Information
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NPI Number | 1376075408
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Entity Type | Organization
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Legal Business Name | TYSON URGENT CARE, LLC
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Dates
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Enumeration Date | 03/29/2017
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Last Update Date | 07/31/2018
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Provider Practice Location Address
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Address Line | 20070 ASHBROOK COMMONS PLZ
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City | ASHBURN
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State | VA
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Zip | 20147
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Country | US
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Telephone | 410-616-9027
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Fax | 410-616-9854
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Provider Business Mailing Address
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Address Line | 8000 LOCH RAVEN BLVD
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City | TOWSON
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State | MD
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Zip | 21286-8337
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Country | US
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Telephone | 410-616-9027
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Fax | 410-616-9854
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Authorized Official
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Title or Position | DIRECTOR
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Name | RACHELLE SHELIA BAILEY-EL
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Credential |
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Telephone | 410-616-9027
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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 | 0101247765
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License Number State | VA
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