MEDICARE: DYNAMIC MEDICAL URGENT CARE OF LIMEKILN PIKE

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	MD422335	PA
2	261Q00000X	Clinic/Center	MD422335	PA

General Provider Information

NPI Number	:	1396178323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC MEDICAL URGENT CARE OF LIMEKILN PIKE

Provider Business Mailing Address
First Line	:	6101 LIMEKILN PIKE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19141-1423
Country	:	US
Telephone Number	:	267-335-3961
Fax Number	:	267-335-3702

Provider Business Practice Location Address
First Line	:	6101 LIMEKILN PIKE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19141-1423
Country	:	US
Telephone Number	:	267-335-3961
Fax Number	:	267-335-3702

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HIGHLAND R CAMPBELL
Credential	:	M.D.
Telephone Number	:	267-335-3961

Provider Enumeration Date	:	08/13/2013
Last Update Date	:	09/10/2013

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