Provider Demographics
NPI:1073767711
Name:HEATHROW URGENT CARE
Entity Type:Organization
Organization Name:HEATHROW URGENT CARE
Other - Org Name:WINTER PARK URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:407-772-2273
Mailing Address - Street 1:1125 TOWNPARK AVE
Mailing Address - Street 2:
Mailing Address - City:HEATHROW
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4791
Mailing Address - Country:US
Mailing Address - Phone:407-772-2273
Mailing Address - Fax:
Practice Address - Street 1:118 W FAIRBANKS AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4327
Practice Address - Country:US
Practice Address - Phone:407-772-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-07
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB916XOtherBCBS WINTER PARK
329964OtherWELLCARE, STAYWELL, HEALTHEASE
329964OtherWELLCARE, STAYWELL, HEALTHEASE
FLH35111Medicare UPIN
FLB916XOtherBCBS WINTER PARK