Provider Demographics
NPI:1962431155
Name:LADYSMITH URGENT CARE CENTER
Entity type:Organization
Organization Name:LADYSMITH URGENT CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUDHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:GULATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-448-4885
Mailing Address - Street 1:17428 CENTER DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:RUTHER GLEN
Mailing Address - State:VA
Mailing Address - Zip Code:22546-2885
Mailing Address - Country:US
Mailing Address - Phone:804-448-4885
Mailing Address - Fax:804-448-4886
Practice Address - Street 1:17428 CENTER DR
Practice Address - Street 2:SUITE E
Practice Address - City:RUTHER GLEN
Practice Address - State:VA
Practice Address - Zip Code:22546-2885
Practice Address - Country:US
Practice Address - Phone:804-448-4885
Practice Address - Fax:804-448-4886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233881208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty