Healthcare Provider Details

I. General information

NPI: 1053070508
Provider Name (Legal Business Name): MAJESTIC URGENT CARE 2 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 12/13/2021
Certification Date: 11/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1672 PLEASANT HILL RD
KISSIMMEE FL
34746-3954
US

IV. Provider business mailing address

1672 PLEASANT HILL RD
KISSIMMEE FL
34746-3954
US

V. Phone/Fax

Practice location:
  • Phone: 407-350-4840
  • Fax: 407-350-5806
Mailing address:
  • Phone: 954-461-5981
  • 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: WILLY NOEL
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 954-461-5981