MEDICARE: MEDSTAR 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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1750718763
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDSTAR URGENT CARE, LLC

Provider Business Mailing Address
First Line	:	1805 COLUMBIA RD NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20009-2001
Country	:	US
Telephone Number	:	202-797-4960
Fax Number	:	202-797-4961

Provider Business Practice Location Address
First Line	:	1805 COLUMBIA RD NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20009-2001
Country	:	US
Telephone Number	:	202-797-4960
Fax Number	:	202-797-4961

Authorized Official
Title or Position	:	CORPORATE VICE PRESIDENT
Name	:	DEBORA KUCHKA-CRAIG
Credential	:
Telephone Number	:	410-772-6827

Provider Enumeration Date	:	10/04/2013
Last Update Date	:	10/04/2013

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