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General NPI Number Information
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NPI Number | 1285727081
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Entity Type | Organization
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Legal Business Name | MELBOURNE URGENT CARE, INC
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 04/01/2009
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Provider Practice Location Address
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Address Line | 395 S WICKHAM RD
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City | W MELBOURNE
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State | FL
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Zip | 32904-1123
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Country | US
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Telephone | 321-953-9981
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Fax | 321-953-0219
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Provider Business Mailing Address
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Address Line | 395 S WICKHAM RD
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City | W MELBOURNE
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State | FL
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Zip | 32904-1123
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Country | US
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Telephone | 321-953-9981
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Fax | 321-953-0219
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Authorized Official
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Title or Position | OWNER
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Name | KRISHNA S VARA
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Credential | M.D
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Telephone | 321-953-9981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | ME88505
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License Number State | FL
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