Provider Demographics
NPI:1275698185
Name:PLANTATION URGENT CARE GROUP LLC
Entity Type:Organization
Organization Name:PLANTATION URGENT CARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHARLOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-797-2900
Mailing Address - Street 1:901 S STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-4522
Mailing Address - Country:US
Mailing Address - Phone:954-797-2900
Mailing Address - Fax:954-792-4601
Practice Address - Street 1:901 S STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-4522
Practice Address - Country:US
Practice Address - Phone:954-797-2900
Practice Address - Fax:954-792-4601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4824Medicare ID - Type Unspecified