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General NPI Number Information
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NPI Number | 1831838762
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Entity Type | Organization
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Legal Business Name | MED 1ST WALKIN CLINIC AND PRIMARY CARE
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Dates
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Enumeration Date | 05/31/2022
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Last Update Date | 06/02/2022
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Provider Practice Location Address
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Address Line | 15 S CENTRE ST
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City | CUMBERLAND
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State | MD
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Zip | 21502-3017
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Country | US
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Telephone | 240-362-7279
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Fax | 240-362-7096
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Provider Business Mailing Address
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Address Line | 15 S CENTRE ST
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City | CUMBERLAND
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State | MD
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Zip | 21502-3017
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Country | US
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Telephone | 240-362-7279
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Fax | 240-362-7096
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | BILLIE FULLER
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Credential |
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Telephone | 301-268-4064
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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 |
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License Number State |
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