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General NPI Number Information
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NPI Number | 1871035527
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Entity Type | Organization
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Legal Business Name | YOUR DOCTORS URGENT CARE & PAIN RELIEF CENTER,LLC
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Dates
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Enumeration Date | 11/12/2016
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Last Update Date | 11/12/2016
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Provider Practice Location Address
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Address Line | 177 SAINT PATRICKS DR
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City | WALDORF
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State | MD
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Zip | 20603-5532
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Country | US
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Telephone | 301-396-4444
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Fax | 301-396-4449
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Provider Business Mailing Address
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Address Line | 177 SAINT PATRICKS DR
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City | WALDORF
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State | MD
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Zip | 20603-5532
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Country | US
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Telephone | 301-396-4444
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Fax | 301-396-4449
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Authorized Official
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Title or Position | PROVIDER
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Name | MR. OLAYINKA OLASIMBO
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Credential | PA-C
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Telephone | 301-396-4444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | D0040209
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License Number State | MD
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