Basic Information
Provider Information
NPI: 1477716108
EntityType: 2
ReplacementNPI:  
OrganizationName: MEDEXPRESS URGENT CARE OF WEST BOCA RATON LLC
LastName:  
FirstName:  
MiddleName:  
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Credential:  
OtherOrganizationName:  
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Mailing Information
Address1: 19090 STATE ROAD 7
Address2:  
City: BOCA RATON
State: FL
PostalCode: 334984763
CountryCode: US
TelephoneNumber: 5613144650
FaxNumber:  
Practice Location
Address1: 19090 STATE ROAD 7
Address2:  
City: BOCA RATON
State: FL
PostalCode: 334984763
CountryCode: US
TelephoneNumber: 5613144650
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/02/2008
LastUpdateDate: 01/13/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: NEAL
AuthorizedOfficialFirstName: ARLENE
AuthorizedOfficialMiddleName: S
AuthorizedOfficialTitleorPosition: DIRECTOR BUSINESS OPERATIONS
AuthorizedOfficialTelephone: 5614249319
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QU0200X  Y Ambulatory Health Care FacilitiesClinic/CenterUrgent Care

No ID Information.


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