Basic Information
| Provider Information | |||||||||
| NPI: | 1942553821 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDFAST URGENT CARE CENTERS. LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 490 CENTRE LAKE DR NE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | PALM BAY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329071113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218907052 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1400 ROCKLEDGE BLVD | ||||||||
| Address2: | |||||||||
| City: | ROCKLEDGE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329552846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3216333278 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2012 | ||||||||
| LastUpdateDate: | 07/14/2021 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | THOMAS | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3217358960 | ||||||||
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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 | OS6588 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.