| Organization Name: | MAINLINE URGENT CARE MEDICAL GROUP P.C |
| NPI Number: | 1275993495 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MAURICE NATHANIEL REID (CEO/MD) |
| Mailing Address: | 3193 Cape Horn Rd Red Lion |
| State: | PA US |
| Postal Code: | 173568810 |
| Phone Number: | 6104824949 |
| Fax Number: | |
| NPI Enumeration Date: | 03/01/2016 |
| NPI Last Update Date: | 06/03/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | MD442240 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |