MEDICARE: LADYSMITH URGENT CARE CENTER

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	208600000X	Surgery Physician	0101233881	VA

General Provider Information

NPI Number	:	1962431155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LADYSMITH URGENT CARE CENTER

Provider Business Mailing Address
First Line	:	17428 CENTER DR
Second Line	:	SUITE E
City	:	RUTHER GLEN
State	:	VA
Zip	:	22546-2885
Country	:	US
Telephone Number	:	804-448-4885
Fax Number	:	804-448-4886

Provider Business Practice Location Address
First Line	:	17428 CENTER DR
Second Line	:	SUITE E
City	:	RUTHER GLEN
State	:	VA
Zip	:	22546-2885
Country	:	US
Telephone Number	:	804-448-4885
Fax Number	:	804-448-4886

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	SUDHIR GULATI
Credential	:	M.D.
Telephone Number	:	804-448-4885

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	08/22/2020

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