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General NPI Number Information
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NPI Number | 1801347695
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Entity Type | Organization
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Legal Business Name | CONVENIENCE URGENT CARE
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Dates
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Enumeration Date | 10/17/2016
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Last Update Date | 10/17/2016
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Provider Practice Location Address
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Address Line | 15521 REAL ESTATE AVE SUITE 206
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City | KING GEORGE
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State | VA
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Zip | 22485-5327
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Country | US
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Telephone | 347-751-3641
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Fax |
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Provider Business Mailing Address
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Address Line | 1010 W KENSINGTON CIR
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-8003
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MD
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Name | JEAN LAURORE
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Credential |
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Telephone | 347-751-3641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101243632
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License Number State | VA
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