Basic Information
| Provider Information | |||||||||
| NPI: | 1396950911 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | URBAN MEDICAL INSTITUTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 LIBERTY HEIGHTS AVE | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212157804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103623000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2600 LIBERTY HEIGHTS AVE | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212157804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103623000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KEANE | ||||||||
| AuthorizedOfficialFirstName: | BERNADETTE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4103624499 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
No ID Information.