MEDICARE: DAVIE 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	261QU0200X	Urgent Care Clinic/Center	L10000015662	FL

General Provider Information

NPI Number	:	1265756563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVIE URGENT CARE LLC

Provider Business Mailing Address
First Line	:	350 N PINE ISLAND RD
Second Line	:	SUITE 200
City	:	PLANTATION
State	:	FL
Zip	:	33324-1849
Country	:	US
Telephone Number	:	954-476-8800
Fax Number	:	954-476-1362

Provider Business Practice Location Address
First Line	:	4765 SW 148TH AVE
Second Line	:	SUITE 401
City	:	DAVIE
State	:	FL
Zip	:	33330-2128
Country	:	US
Telephone Number	:	954-476-8800
Fax Number	:	954-476-1362

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. CHRISTOPHER A BROWN
Credential	:	M.D.
Telephone Number	:	954-476-8800

Provider Enumeration Date	:	03/16/2010
Last Update Date	:	05/25/2010

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