MEDICARE: COMPREHENSIVE URGENT CARE INC.

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	302R00000X	Health Maintenance Organization	0S4440	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184863151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE URGENT CARE INC.

Provider Business Mailing Address
First Line	:	671 NW 119TH ST
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33168-2522
Country	:	US
Telephone Number	:	305-688-0811
Fax Number	:	305-687-5831

Provider Business Practice Location Address
First Line	:	671 NW 119TH ST
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33168-2522
Country	:	US
Telephone Number	:	305-688-0188
Fax Number	:	305-687-5831

Authorized Official
Title or Position	:	CEO
Name	:	DR. RUDOLPH GUY MOISE
Credential	:	D.O.
Telephone Number	:	305-688-0811

Provider Enumeration Date	:	02/13/2009
Last Update Date	:	02/13/2009

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