=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912378894
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WALKING URGENT CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2015
-----------------------------------------------------
Last Update Date | 02/11/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10308 W SAMPLE RD
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33065-3942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-755-4880
-----------------------------------------------------
Fax | 954-755-0861
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 9851
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33075-0851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-755-4880
-----------------------------------------------------
Fax | 954-755-0861
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. NASEH NAWABI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 818-815-9172
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | ME114198
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number | ME114198
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------