MEDICARE: FRIENDLY 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	208VP0000X	Pain Medicine Physician
2	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1851698401
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRIENDLY URGENT CARE, INC

Provider Business Mailing Address
First Line	:	3121 W HALLANDALE BEACH BLVD
Second Line	:	SUITE 101
City	:	HALLANDALE
State	:	FL
Zip	:	33009-5149
Country	:	US
Telephone Number	:	305-533-8478
Fax Number	:	305-337-6305

Provider Business Practice Location Address
First Line	:	3121 W HALLANDALE BEACH BLVD
Second Line	:	SUITE 101
City	:	HALLANDALE
State	:	FL
Zip	:	33009-5149
Country	:	US
Telephone Number	:	305-533-8478
Fax Number	:	305-337-6305

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	CATHLEEN CAREW
Credential	:
Telephone Number	:	305-533-8478

Provider Enumeration Date	:	02/17/2011
Last Update Date	:	02/17/2011

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