MEDICARE: JACKSONVILLE URGENT CARE LLC

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	ME97989	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	:	1194962142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSONVILLE URGENT CARE LLC

Provider Business Mailing Address
First Line	:	1126 UNIVERSITY BLVD N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-8850
Country	:	US
Telephone Number	:	832-651-0323
Fax Number	:

Provider Business Practice Location Address
First Line	:	1126 UNIVERSITY BLVD N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-8850
Country	:	US
Telephone Number	:	832-651-0323
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHIDI UCHE
Credential	:	MD
Telephone Number	:	832-651-0323

Provider Enumeration Date	:	01/13/2009
Last Update Date	:	10/31/2014

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