MEDICARE: MAIN LINE URGENT CARE MEDICAL GROUP PC

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	:	1790111284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAIN LINE URGENT CARE MEDICAL GROUP PC

Provider Business Mailing Address
First Line	:	1505 E CHURCHVILLE RD
Second Line	:
City	:	BEL AIR
State	:	MD
Zip	:	21014-4742
Country	:	US
Telephone Number	:	410-420-6970
Fax Number	:	410-420-6650

Provider Business Practice Location Address
First Line	:	213 MORTON AVE
Second Line	:
City	:	FOLSOM
State	:	PA
Zip	:	19033-3023
Country	:	US
Telephone Number	:	610-285-9500
Fax Number	:	610-237-8701

Authorized Official
Title or Position	:	CEO
Name	:	MAURICE N REID
Credential	:
Telephone Number	:	410-569-0044

Provider Enumeration Date	:	09/17/2013
Last Update Date	:	05/04/2018

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