Healthcare Provider Details

I. General information

NPI: 1619017647
Provider Name (Legal Business Name): ER URGENT CARE MANAGEMENT CO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 IVES DAIRY RD
NORTH MIAMI BEACH FL
33179-2425
US

IV. Provider business mailing address

5535 MEMORIAL HWY
TAMPA FL
33634-7370
US

V. Phone/Fax

Practice location:
  • Phone: 305-917-9170
  • Fax: 305-917-9173
Mailing address:
  • Phone: 813-886-0689
  • Fax: 813-579-9693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME93886
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME74933
License Number StateFL

VIII. Authorized Official

Name: MR. MICHAEL A OLIVER
Title or Position: PRESIDENT
Credential:
Phone: 305-999-0247