=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518149657
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A PLUS URGENT CARE OF HOLLYWOOD, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2007
-----------------------------------------------------
Last Update Date | 04/17/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1531 N FEDERAL HWY
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33020-2849
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-663-5066
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1531 N FEDERAL HWY
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33020-2849
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-663-5066
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MGRM
-----------------------------------------------------
Name | MR. DEREK GOETZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-922-8585
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------