Provider Demographics
NPI:1407283468
Name:PROFESSIONAL URGENT CARE SERVICES
Entity Type:Organization
Organization Name:PROFESSIONAL URGENT CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHITAL-HITEN
Authorized Official - Middle Name:
Authorized Official - Last Name:UPADHYAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-528-7827
Mailing Address - Street 1:640 TYRONE BLVD N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-7126
Mailing Address - Country:US
Mailing Address - Phone:727-528-7827
Mailing Address - Fax:727-528-7337
Practice Address - Street 1:640 TYRONE BLVD N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-7126
Practice Address - Country:US
Practice Address - Phone:727-528-7827
Practice Address - Fax:727-528-7337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-04
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80430261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care