Provider Demographics
NPI:1184863151
Name:COMPREHENSIVE URGENT CARE INC.
Entity Type:Organization
Organization Name:COMPREHENSIVE URGENT CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RUDOLPH
Authorized Official - Middle Name:GUY
Authorized Official - Last Name:MOISE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-688-0811
Mailing Address - Street 1:671 NW 119TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168-2522
Mailing Address - Country:US
Mailing Address - Phone:305-688-0811
Mailing Address - Fax:305-687-5831
Practice Address - Street 1:671 NW 119TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168-2522
Practice Address - Country:US
Practice Address - Phone:305-688-0188
Practice Address - Fax:305-687-5831
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPREHENSIVE HEALTH CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0S4440302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL68084200Medicaid