Healthcare Provider Details

I. General information

NPI: 1720439557
Provider Name (Legal Business Name): MEDPRO URGENT CARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 GRIFFIN RD
FORT LAUDERDALE FL
33312-5648
US

IV. Provider business mailing address

2950 GRIFFIN RD
FORT LAUDERDALE FL
33312-5648
US

V. Phone/Fax

Practice location:
  • Phone: 954-924-6151
  • Fax:
Mailing address:
  • Phone: 954-924-6151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberOS10911
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANETA DADASHEVA
Title or Position: PRESIDENT
Credential:
Phone: 954-924-6151