MEDICARE: URGENTCARE USA FISHHAWK

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	261QU0200X	Urgent Care Clinic/Center	HCC7634	FL

General Provider Information

NPI Number	:	1255628475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	URGENTCARE USA FISHHAWK

Provider Business Mailing Address
First Line	:	5464 LITHIA PINECREST RD
Second Line	:
City	:	LITHIA
State	:	FL
Zip	:	33547-2853
Country	:	US
Telephone Number	:	813-681-2111
Fax Number	:	813-681-2611

Provider Business Practice Location Address
First Line	:	5464 LITHIA PINECREST RD
Second Line	:
City	:	LITHIA
State	:	FL
Zip	:	33547-2853
Country	:	US
Telephone Number	:	813-681-2111
Fax Number	:	813-681-2611

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. MICHAEL ANTHONY SALVATO
Credential	:	M.D.
Telephone Number	:	813-681-2111

Provider Enumeration Date	:	07/08/2011
Last Update Date	:	07/08/2011

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