MEDICARE: CYNERGY 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

General Provider Information

NPI Number	:	1376785758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CYNERGY URGENT CARE, LLC

Provider Business Mailing Address
First Line	:	4692 EXPLORATION AVE
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33812-4107
Country	:	US
Telephone Number	:	863-644-0888
Fax Number	:

Provider Business Practice Location Address
First Line	:	4692 EXPLORATION AVE
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33812-4107
Country	:	US
Telephone Number	:	863-644-0888
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	ROBERT MINER
Credential	:
Telephone Number	:	407-340-6651

Provider Enumeration Date	:	03/31/2009
Last Update Date	:	05/05/2009

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