MEDICARE: GARDENS URGENT CARE OF LAKE WORTH 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	ME76345	FL

General Provider Information

NPI Number	:	1679876619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARDENS URGENT CARE OF LAKE WORTH LLC

Provider Business Mailing Address
First Line	:	7408 LAKE WORTH RD STE 700
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2531
Country	:	US
Telephone Number	:	561-721-7227
Fax Number	:	561-721-7228

Provider Business Practice Location Address
First Line	:	7408 LAKE WORTH RD STE 700
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2531
Country	:	US
Telephone Number	:	561-721-7227
Fax Number	:	561-721-7228

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. MATTHEW TYLER THOMAS
Credential	:	M.D.
Telephone Number	:	561-721-7227

Provider Enumeration Date	:	12/14/2010
Last Update Date	:	12/14/2010

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