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General NPI Number Information
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NPI Number | 1720439557
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Entity Type | Organization
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Legal Business Name | MEDPRO URGENT CARE CENTER, INC
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Dates
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Enumeration Date | 06/22/2016
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Last Update Date | 01/14/2022
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Provider Practice Location Address
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Address Line | 2950 GRIFFIN RD
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City | FORT LAUDERDALE
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State | FL
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Zip | 33312-5648
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Country | US
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Telephone | 954-924-6151
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Fax |
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Provider Business Mailing Address
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Address Line | 2950 GRIFFIN RD
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City | FORT LAUDERDALE
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State | FL
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Zip | 33312-5648
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Country | US
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Telephone | 954-924-6151
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANETA DADASHEVA
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Credential |
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Telephone | 954-924-6151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | OS10911
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License Number State | FL
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Taxonomy #2
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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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