MEDICARE: MEDGEN URGENT CARE VIRGINIA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1033500079
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDGEN URGENT CARE VIRGINIA LLC

Provider Business Mailing Address
First Line	:	6841 ELM ST
Second Line	:	#916
City	:	MC LEAN
State	:	VA
Zip	:	22101-0916
Country	:	US
Telephone Number	:	202-258-1627
Fax Number	:	844-213-1098

Provider Business Practice Location Address
First Line	:	3117 DUKE ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-4518
Country	:	US
Telephone Number	:	703-751-8800
Fax Number	:

Authorized Official
Title or Position	:	PART OWNER
Name	:	CLELIA WALTERS
Credential	:
Telephone Number	:	202-258-1627

Provider Enumeration Date	:	02/12/2015
Last Update Date	:	04/10/2019

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