Provider Demographics
NPI:1164893095
Name:BOULEVARD URGENT CARE & FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:BOULEVARD URGENT CARE & FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARHOUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-291-5000
Mailing Address - Street 1:1808 E SILVER SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-6921
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1808 E SILVER SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-6921
Practice Address - Country:US
Practice Address - Phone:352-291-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty