Basic Information
| Provider Information | |||||||||
| NPI: | 1235617432 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDFAST URGENT CARE CENTERS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7925 N. WICKHAM RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3217517222 | ||||||||
| FaxNumber: | 3218214955 | ||||||||
| Practice Location | |||||||||
| Address1: | 390 N. COURTENAY PKWY | ||||||||
| Address2: | |||||||||
| City: | MERRITT ISLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3216333162 | ||||||||
| FaxNumber: | 3218214955 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2018 | ||||||||
| LastUpdateDate: | 07/13/2021 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/CMO | ||||||||
| AuthorizedOfficialTelephone: | 3216333162 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
| NPICertificationDate: | 07/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.