1003236001 NPI number — HEALTHY CHOICE FAMILY CLINIC AND URGENT CARE, LLC

Table of content: (NPI 1003236001)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003236001 NPI number — HEALTHY CHOICE FAMILY CLINIC AND URGENT CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHY CHOICE FAMILY CLINIC AND URGENT CARE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003236001
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8700 CENTRAL AVE
Provider Second Line Business Mailing Address:
SUITE 302 A
Provider Business Mailing Address City Name:
LANDOVER
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20785-4831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-613-9295
Provider Business Mailing Address Fax Number:
888-202-7717

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8700 CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE # 302A
Provider Business Practice Location Address City Name:
LANDOVER
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20785-4831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-613-9295
Provider Business Practice Location Address Fax Number:
888-202-7717
Provider Enumeration Date:
04/17/2014

Additional Information

Authorized Official

Authorized Official Last Name:
TITUS
Authorized Official First Name:
VICTORIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT /OWNER
Authorized Official Telephone Number:
301-613-9295

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  R184425 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: R184425 . This is a "MARYLAND STATE LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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