Healthcare Provider Details

I. General information

NPI: 1396997532
Provider Name (Legal Business Name): LAKEWOOD RANCH URGENT CARE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 09/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4647 MANATEE AVE W
BRADENTON FL
34209-3849
US

IV. Provider business mailing address

7322 MANATEE AVE W #108
BRADENTON FL
34209
US

V. Phone/Fax

Practice location:
  • Phone: 941-745-5999
  • Fax: 941-749-5915
Mailing address:
  • Phone: 941-447-5854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC M FOLKENS
Title or Position: PROVIDER
Credential: MD
Phone: 941-447-5854