Provider Demographics
NPI:1053622019
Name:ACE URGENT CARE AND CLINIC LLC
Entity type:Organization
Organization Name:ACE URGENT CARE AND CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:OLUBAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:OLUDARA-FADARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-220-2277
Mailing Address - Street 1:PO BOX 837
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20768-0837
Mailing Address - Country:US
Mailing Address - Phone:301-220-2277
Mailing Address - Fax:301-220-4464
Practice Address - Street 1:7347 HANOVER PKWY STE B
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3663
Practice Address - Country:US
Practice Address - Phone:301-220-2277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-24
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care