=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518067768
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JUPITER URGENT CARE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1335 W INDIANTOWN RD
-----------------------------------------------------
City | JUPITER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33458-4631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-744-9995
-----------------------------------------------------
Fax | 561-744-8215
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1335 W INDIANTOWN RD
-----------------------------------------------------
City | JUPITER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33458-4631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-744-9995
-----------------------------------------------------
Fax | 561-744-8215
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DON TANABE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 561-744-9995
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------