Provider Demographics
NPI:1083953467
Name:CHIRON URGENT CARE LLC
Entity Type:Organization
Organization Name:CHIRON URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BIJU
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-383-7600
Mailing Address - Street 1:603 N WASHINGTON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2107
Mailing Address - Country:US
Mailing Address - Phone:321-264-7688
Mailing Address - Fax:
Practice Address - Street 1:603 N WASHINGTON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2107
Practice Address - Country:US
Practice Address - Phone:321-264-7688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 82886207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG7190AMedicare PIN