Basic Information
| Provider Information | |||||||||
| NPI: | 1740606276 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDFAST URGENT CARE CENTERS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3045 COLUMBIA BLVD STE 108A | ||||||||
| Address2: | |||||||||
| City: | TITUSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327807864 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3045 COLUMBIA BLVD STE A108 | ||||||||
| Address2: | |||||||||
| City: | TITUSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327807864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3216333278 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2014 | ||||||||
| LastUpdateDate: | 07/13/2021 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | THOMAS | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3212649176 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
| NPICertificationDate: | 07/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.