MEDICARE: SOMO URGENT CARE, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0850X	Adult Mental Health Clinic/Center
2	363LP2300X	Primary Care Nurse Practitioner
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1609641703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOMO URGENT CARE, INC

Provider Business Mailing Address
First Line	:	3010 CRAIN HWY STE 300
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20601-2838
Country	:	US
Telephone Number	:	301-532-6811
Fax Number	:

Provider Business Practice Location Address
First Line	:	3010 CRAIN HWY STE 300
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20601-2838
Country	:	US
Telephone Number	:	301-760-0335
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SANDYS OBEN EYONG
Credential	:
Telephone Number	:	301-532-6811

Provider Enumeration Date	:	11/17/2023
Last Update Date	:	08/11/2024

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