Healthcare Provider Details

I. General information

NPI: 1770909152
Provider Name (Legal Business Name): WINTER GARDEN URGENT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2014
Last Update Date: 07/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 S DILLARD ST UNIT A
WINTER GARDEN FL
34787-3908
US

IV. Provider business mailing address

736 S DILLARD ST UNIT A
WINTER GARDEN FL
34787-3908
US

V. Phone/Fax

Practice location:
  • Phone: 407-656-0505
  • Fax: 407-656-0505
Mailing address:
  • Phone: 407-656-7000
  • Fax: 407-656-7005

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: HARBINDER GHULLDU
Title or Position: MGR
Credential: MD
Phone: 407-370-9783