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General NPI Number Information
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NPI Number | 1417772666
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Entity Type | Organization
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Legal Business Name | MEDFAST URGENT CARE CENTERS, LLC
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 2330 N WICKHAM RD STE 12
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City | MELBOURNE
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State | FL
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Zip | 32935-8184
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Country | US
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Telephone | 321-633-3278
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Fax | 321-684-7872
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Provider Business Mailing Address
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Address Line | 390 N COURTENAY PKWY
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-3456
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BILLING CODER
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Name | HOLLY J CASSANO
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Credential |
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Telephone | 844-591-1998
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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 |
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License Number State |
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