Provider Demographics
NPI:1093905986
Name:URGENT CARE CENTER OF LONGWOOD LLC
Entity Type:Organization
Organization Name:URGENT CARE CENTER OF LONGWOOD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WASIM
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-212-3000
Mailing Address - Street 1:450 W STATE ROAD 434 STE 1010
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5187
Mailing Address - Country:US
Mailing Address - Phone:407-212-3000
Mailing Address - Fax:407-212-3001
Practice Address - Street 1:450 W STATE ROAD 434 STE 1010
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5187
Practice Address - Country:US
Practice Address - Phone:407-212-3000
Practice Address - Fax:407-212-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL247855139OtherURGENT CARE-ACHA EXEMPT