Provider Demographics
NPI:1396405718
Name:SPACE COAST URGENT CARE LLC
Entity Type:Organization
Organization Name:SPACE COAST URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:TORPY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-722-7556
Mailing Address - Street 1:468 BIMINI LN
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4411
Mailing Address - Country:US
Mailing Address - Phone:321-427-5672
Mailing Address - Fax:
Practice Address - Street 1:890 E EAU GALLIE BLVD
Practice Address - Street 2:
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-4903
Practice Address - Country:US
Practice Address - Phone:321-722-7556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-27
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care