Provider Demographics
NPI:1508159864
Name:DOCTORS IN AND OUT URGENT CARE
Entity Type:Organization
Organization Name:DOCTORS IN AND OUT URGENT CARE
Other - Org Name:IN THE BLACK MD
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-831-6707
Mailing Address - Street 1:2016 E STATE ROAD 60
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-3605
Mailing Address - Country:US
Mailing Address - Phone:813-831-6707
Mailing Address - Fax:813-831-6707
Practice Address - Street 1:2016 E STATE ROAD 60
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594-3605
Practice Address - Country:US
Practice Address - Phone:813-831-6707
Practice Address - Fax:813-831-6707
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IN THE BLACK MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care