MEDICARE: MELBOURNE URGENT CARE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center	ME88505	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285727081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELBOURNE URGENT CARE, INC

Provider Business Mailing Address
First Line	:	395 S WICKHAM RD
Second Line	:
City	:	W MELBOURNE
State	:	FL
Zip	:	32904-1123
Country	:	US
Telephone Number	:	321-953-9981
Fax Number	:	321-953-0219

Provider Business Practice Location Address
First Line	:	395 S WICKHAM RD
Second Line	:
City	:	W MELBOURNE
State	:	FL
Zip	:	32904-1123
Country	:	US
Telephone Number	:	321-953-9981
Fax Number	:	321-953-0219

Authorized Official
Title or Position	:	OWNER
Name	:	KRISHNA S VARA
Credential	:	M.D
Telephone Number	:	321-953-9981

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	04/01/2009

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