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Organization
LOWER SHORE IMMEDIATE CARE LLC
Active
Organization
LOWER SHORE IMMEDIATE CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM FROCK (CONTRACTING AND CREDENTIALING)
(605) 789-6661
Entity
Organization
Contact information
Practice address
12302 SOMERSET AVE, SUITE A/B, PRINCESS ANNE, MD 21853-3099
(410) 651-0300
(302) 947-4433
Mailing address
12302 SOMERSET AVE, SUITE A/B, PRINCESS ANNE, MD 21853-3099
(410) 651-0300
(302) 947-4433
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
261QU0200X
Urgent Care Clinic/Center
Primary
—
NULL
363AM0700X
Medical Physician Assistant
—
NULL
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
04/22/2016
Last updated
12/02/2016
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