Organization
PREVENTION &MANAGEMENT OUTREACH CLINIC INC.
Active
Parent organization
438-31-0969
Other names
Prevention & Management Outreach Clinic Inc.
Organization subpart
Yes
Provider details
NPI number
Legal business name
438-31-0969
Authorized official
MS. LISA BUSH (PRESIDENT/CEO)
(410) 312-3126
Entity
Organization
Contact information
Practice address
5941 MILLRACE CT UNIT D103, COLUMBIA, MD 21045-7204
(410) 312-3126
Mailing address
5941 MILLRACE CT UNIT D103, COLUMBIA, MD 21045-7204
(410) 312-3126
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
0000000000
MD
305R00000X
Preferred Provider Organization
30500000X
MD
305R00000X
Preferred Provider Organization
—
MD
305R00000X
Preferred Provider Organization
Primary
—
—
Other
Enumeration date
11/19/2008
Last updated
11/19/2008
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