MEDICARE: PHYSICIAN ACCESS URGENT CARE GROUP, 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	171W00000X	Contractor		FL

General Provider Information

NPI Number	:	1508032061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIAN ACCESS URGENT CARE GROUP, LLC

Provider Business Mailing Address
First Line	:	655 NW 119TH ST
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33168-2522
Country	:	US
Telephone Number	:	305-403-2219
Fax Number	:	786-517-3391

Provider Business Practice Location Address
First Line	:	655 NW 119TH ST
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33168-2522
Country	:	US
Telephone Number	:	305-403-2219
Fax Number	:	786-517-3391

Authorized Official
Title or Position	:	PRESIDENT / CEO
Name	:	DR. RUDOLPH MOISE
Credential	:	D.O.
Telephone Number	:	305-403-2219

Provider Enumeration Date	:	05/05/2008
Last Update Date	:	04/11/2016

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