Provider Demographics
NPI:1457823080
Name:MEDFAST URGENT CARE CENTER, LLC
Entity Type:Organization
Organization Name:MEDFAST URGENT CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BELANGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-676-0558
Mailing Address - Street 1:7925 N WICKHAM RD STE A
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8211
Mailing Address - Country:US
Mailing Address - Phone:321-751-7222
Mailing Address - Fax:321-751-6655
Practice Address - Street 1:2113 SARNO RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3001
Practice Address - Country:US
Practice Address - Phone:321-419-0797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDFAST URGENT CARE CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-20
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center