MEDICARE: URGENT CARE OF BROWARD, INC.

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	173000000X	Legal Medicine	ME 43064	FL

General Provider Information

NPI Number	:	1639301443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	URGENT CARE OF BROWARD, INC.

Provider Business Mailing Address
First Line	:	PO BOX 16404
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33318-6404
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4121 NW 5TH ST
Second Line	:	215
City	:	PLANTATION
State	:	FL
Zip	:	33317-2120
Country	:	US
Telephone Number	:	954-583-0504
Fax Number	:	954-583-0610

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JESSEH RAMAIN
Credential	:
Telephone Number	:	954-583-0504

Provider Enumeration Date	:	08/12/2009
Last Update Date	:	08/12/2009

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