Provider Demographics
NPI:1508101619
Name:OCEANSIDE URGENT CARE LLC
Entity Type:Organization
Organization Name:OCEANSIDE URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOEBEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:772-546-4215
Mailing Address - Street 1:1335 W INDIANTOWN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-4631
Mailing Address - Country:US
Mailing Address - Phone:561-744-9995
Mailing Address - Fax:561-744-8215
Practice Address - Street 1:1335 W INDIANTOWN RD
Practice Address - Street 2:SUITE B
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4631
Practice Address - Country:US
Practice Address - Phone:561-744-9995
Practice Address - Fax:561-744-8215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8519261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care