MEDICARE: LAS OLAS URGENT CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician
2	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1174743744
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAS OLAS URGENT CARE

Provider Business Mailing Address
First Line	:	2607 NE 10TH AVE
Second Line	:
City	:	WILTON MANORS
State	:	FL
Zip	:	33334-3707
Country	:	US
Telephone Number	:	954-763-1230
Fax Number	:

Provider Business Practice Location Address
First Line	:	2607 NE 10TH AVE
Second Line	:
City	:	WILTON MANORS
State	:	FL
Zip	:	33334-3707
Country	:	US
Telephone Number	:	954-763-1230
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	JEANNETTE GARZON
Credential	:
Telephone Number	:	954-763-1230

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	08/12/2009

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