Healthcare Provider Details

I. General information

NPI: 1164064200
Provider Name (Legal Business Name): MEDFAST URGENT CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S RIDGEWOOD AVE
EDGEWATER FL
32132-2333
US

IV. Provider business mailing address

390 N COURTENAY PKWY
MERRITT ISLAND FL
32953-3456
US

V. Phone/Fax

Practice location:
  • Phone: 386-220-8222
  • Fax: 386-220-8233
Mailing address:
  • Phone: 321-633-3162
  • 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: MARILYN STEVENS
Title or Position: BILLING DIRECTOR
Credential:
Phone: 321-821-4950