Embrey Mill Primary And Urgent Care Llc | |
1610 Publix Way # B112 Stafford VA 22554-7783 | |
(571) 332-2439 | |
Not Available |
Full Name | Embrey Mill Primary And Urgent Care Llc |
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Speciality | General Practice |
Location | 1610 Publix Way # B112, Stafford, Virginia |
Authorized Official Name and Position | Galam A Khan (AUTHORIZED OFFICIAL) |
Authorized Official Contact | 5713322439 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Embrey Mill Primary And Urgent Care Llc 1610 Publix Way # B112 Stafford VA 22554-7783 Ph: () - | Embrey Mill Primary And Urgent Care Llc 1610 Publix Way # B112 Stafford VA 22554-7783 Ph: (571) 332-2439 |
NPI Number | 1790400042 |
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Provider Enumeration Date | 10/10/2022 |
Last Update Date | 11/15/2022 |
Medicare PECOS PAC ID | 8729453949 |
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Medicare Enrollment ID | O20230331000380 |
Identifier | Type | State | Issuer |
---|---|---|---|
1790400042 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | (* (Not Available)) | Primary |
Provider Name | Jennifer S Grillo |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1023344371 PECOS PAC ID: 4981742715 Enrollment ID: I20111130000303 |
Provider Name | Galam Asheaque Khan |
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Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1952628034 PECOS PAC ID: 1254694599 Enrollment ID: I20190619000031 |
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