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General NPI Number Information
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NPI Number | 1508101619
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Entity Type | Organization
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Legal Business Name | OCEANSIDE URGENT CARE LLC
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Dates
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Enumeration Date | 11/29/2012
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Last Update Date | 11/29/2012
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Provider Practice Location Address
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Address Line | 1335 W INDIANTOWN RD SUITE B
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City | JUPITER
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State | FL
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Zip | 33458-4631
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Country | US
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Telephone | 561-744-9995
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Fax | 561-744-8215
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Provider Business Mailing Address
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Address Line | 1335 W INDIANTOWN RD SUITE B
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City | JUPITER
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State | FL
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Zip | 33458-4631
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Country | US
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Telephone | 561-744-9995
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Fax | 561-744-8215
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Authorized Official
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Title or Position | PRESIDENT
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Name | THERESA GOEBEL
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Credential | DO
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Telephone | 772-546-4215
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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 | OS8519
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License Number State | FL
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