MEDICARE: WILLIAM AND TERESA MEDICAL CARE INC

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	:	1689953390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM AND TERESA MEDICAL CARE INC

Provider Business Mailing Address
First Line	:	7516 IRON BAR LN
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-2999
Country	:	US
Telephone Number	:	703-754-9111
Fax Number	:

Provider Business Practice Location Address
First Line	:	7516 IRON BAR LN
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-2999
Country	:	US
Telephone Number	:	703-754-9111
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHARLES IHECHUKWUTURU OKORIE
Credential	:
Telephone Number	:	703-754-9111

Provider Enumeration Date	:	08/11/2011
Last Update Date	:	08/11/2011

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