Provider Demographics
NPI:1457503005
Name:PHYSICIAN ACCESS URGENT CARE GROUP, LLC OF CENTRAL FLORIDA
Entity Type:Organization
Organization Name:PHYSICIAN ACCESS URGENT CARE GROUP, LLC OF CENTRAL FLORIDA
Other - Org Name:PAUC OF CENTRAL FLORIDA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RUDOLPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOISE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:786-517-1530
Mailing Address - Street 1:5575 S SEMORAN BLVD
Mailing Address - Street 2:SUITE 1&2
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-1747
Mailing Address - Country:US
Mailing Address - Phone:786-517-1530
Mailing Address - Fax:786-517-3620
Practice Address - Street 1:9999 NE 2ND AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2352
Practice Address - Country:US
Practice Address - Phone:786-517-1530
Practice Address - Fax:786-517-3620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty