MEDICARE: VIRGINIA 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	:	1972757474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRGINIA URGENT CARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 41007
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28309-1007
Country	:	US
Telephone Number	:	800-849-5609
Fax Number	:	910-483-3959

Provider Business Practice Location Address
First Line	:	330 WHITE OAK ROAD
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22405-0000
Country	:	US
Telephone Number	:	540-373-2424
Fax Number	:	540-373-3258

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LAUREL STOIMENOFF
Credential	:
Telephone Number	:	480-924-8382

Provider Enumeration Date	:	11/11/2008
Last Update Date	:	11/11/2008

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