Healthcare Provider Details

I. General information

NPI: 1023326824
Provider Name (Legal Business Name): ER URGENT CARE & DIAGNOSTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 03/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 NW 5TH ST 100
PLANTATION FL
33317-2180
US

IV. Provider business mailing address

4141 NW 5TH ST 100
PLANTATION FL
33317-2180
US

V. Phone/Fax

Practice location:
  • Phone: 954-581-1581
  • Fax: 954-581-0543
Mailing address:
  • Phone: 954-581-1581
  • Fax: 954-581-0543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH9049
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME43064
License Number StateFL

VIII. Authorized Official

Name: DR. JEAN MARIE EUGENE
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 954-581-1581