MEDICARE: MEDFAST URGENT CARE CENTERS, 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	:	1417772666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDFAST URGENT CARE CENTERS, LLC

Provider Business Mailing Address
First Line	:	390 N COURTENAY PKWY
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-3456
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2330 N WICKHAM RD STE 12
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-8184
Country	:	US
Telephone Number	:	321-633-3278
Fax Number	:	321-684-7872

Authorized Official
Title or Position	:	BILLING CODER
Name	:	HOLLY J CASSANO
Credential	:
Telephone Number	:	844-591-1998

Provider Enumeration Date	:	11/21/2024
Last Update Date	:	11/21/2024

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