Healthcare Provider Details

I. General information

NPI: 1326541897
Provider Name (Legal Business Name): URGENT FAMILY CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11601 S ORANGE BLOSSOM TRL STE 101
ORLANDO FL
32837-9437
US

IV. Provider business mailing address

11601 S ORANGE BLOSSOM TRL STE 101
ORLANDO FL
32837-9437
US

V. Phone/Fax

Practice location:
  • Phone: 407-271-4605
  • Fax: 407-271-4740
Mailing address:
  • Phone: 407-271-4605
  • Fax: 407-271-4740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GERARDO MENA
Title or Position: MANAGER
Credential:
Phone: 407-915-2718