=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164683116
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMERICAN URGENT CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2008
-----------------------------------------------------
Last Update Date | 11/03/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 NE 167 STREET
-----------------------------------------------------
City | NORTH MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33162-2304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-940-0522
-----------------------------------------------------
Fax | 305-653-1138
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 NE 167 STREET
-----------------------------------------------------
City | NORTH MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33162-2304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-940-0522
-----------------------------------------------------
Fax | 305-653-1138
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. VICTOR I. TAMAYO
-----------------------------------------------------
Credential | M. D.
-----------------------------------------------------
Telephone | 305-940-0522
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------