MEDICARE: MELBOURNE URGENT CARE, LLC

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	261Q00000X	Clinic/Center	ME88505	FL

General Provider Information

NPI Number	:	1639178510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELBOURNE URGENT CARE, LLC

Provider Business Mailing Address
First Line	:	187 S WICKHAM RD
Second Line	:	SUITE 101
City	:	MELBOURNE
State	:	FL
Zip	:	32904-1123
Country	:	US
Telephone Number	:	321-953-9981
Fax Number	:	321-953-0212

Provider Business Practice Location Address
First Line	:	187 S WICKHAM RD
Second Line	:	SUITE 101
City	:	MELBOURNE
State	:	FL
Zip	:	32904-1123
Country	:	US
Telephone Number	:	321-953-9981
Fax Number	:	321-953-0212

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	08/22/2020

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