MEDICARE: NORTHERN VIRGINIA CARENOW URGENT CARE, 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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1669101986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN VIRGINIA CARENOW URGENT CARE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 744033
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-4033
Country	:	US
Telephone Number	:	615-373-7600
Fax Number	:

Provider Business Practice Location Address
First Line	:	12214 W BROAD ST STE B
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23233-1062
Country	:	US
Telephone Number	:	804-362-8345
Fax Number	:	855-224-1594

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	TIMOTHY DOUGLAS MILLER
Credential	:
Telephone Number	:	972-906-8103

Provider Enumeration Date	:	06/10/2022
Last Update Date	:	06/10/2022

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