Provider Demographics
NPI:1114236676
Name:MEDIX URGENT CARE CENTER LLC
Entity Type:Organization
Organization Name:MEDIX URGENT CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:J
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:954-530-4355
Mailing Address - Street 1:2331 N STATE ROAD 7 STE 102
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-3771
Mailing Address - Country:US
Mailing Address - Phone:954-530-4355
Mailing Address - Fax:954-530-4355
Practice Address - Street 1:2331 N STATE ROAD 7 STE 102
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-3771
Practice Address - Country:US
Practice Address - Phone:954-530-4355
Practice Address - Fax:954-530-4355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-01
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113649100Medicaid