Basic Information
| Provider Information | |||||||||
| NPI: | 1164064200 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDFAST URGENT CARE CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 390 N COURTENAY PKWY | ||||||||
| Address2: | |||||||||
| City: | MERRITT ISLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329533456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3216333162 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 S RIDGEWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | EDGEWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321322333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3862208222 | ||||||||
| FaxNumber: | 3862208233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2019 | ||||||||
| LastUpdateDate: | 06/17/2020 | ||||||||
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| AuthorizedOfficialLastName: | STEVENS | ||||||||
| AuthorizedOfficialFirstName: | MARILYN | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3218214950 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.