Healthcare Provider Details

I. General information

NPI: 1639178510
Provider Name (Legal Business Name): MELBOURNE URGENT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 S WICKHAM RD SUITE 101
MELBOURNE FL
32904-1123
US

IV. Provider business mailing address

187 S WICKHAM RD SUITE 101
MELBOURNE FL
32904-1123
US

V. Phone/Fax

Practice location:
  • Phone: 321-953-9981
  • Fax: 321-953-0212
Mailing address:
  • Phone: 321-953-9981
  • Fax: 321-953-0212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberME88505
License Number StateFL

VIII. Authorized Official

Name: KRISHNA S VARA
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 321-953-9981