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General NPI Number Information
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NPI Number | 1780040196
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Entity Type | Organization
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Legal Business Name | URGE MEDICAL
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Dates
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Enumeration Date | 01/14/2016
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Last Update Date | 01/14/2016
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Provider Practice Location Address
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Address Line | 4158 DALE BLVD
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City | WOODBRIDGE
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State | VA
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Zip | 22193-2225
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Country | US
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Telephone | 703-680-5959
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Fax | 703-730-1046
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Provider Business Mailing Address
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Address Line | 4158 DALE BLVD
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City | WOODBRIDGE
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State | VA
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Zip | 22193-2225
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Country | US
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Telephone | 703-680-5959
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Fax | 703-730-1046
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JENNIFER LYNN KULAK
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Credential |
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Telephone | 703-680-5959
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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 | 0101259313
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License Number State | VA
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