Provider Demographics
NPI:1598105579
Name:CLEVELAND URGENT CARE & PODIATRIST GROUP, INC.
Entity Type:Organization
Organization Name:CLEVELAND URGENT CARE & PODIATRIST GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:COBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-584-8354
Mailing Address - Street 1:4141 NW 5TH ST
Mailing Address - Street 2:100
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2180
Mailing Address - Country:US
Mailing Address - Phone:954-584-8354
Mailing Address - Fax:954-584-8355
Practice Address - Street 1:4141 NW 5TH ST
Practice Address - Street 2:100
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2180
Practice Address - Country:US
Practice Address - Phone:954-584-8354
Practice Address - Fax:954-584-8355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-05
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90693261QU0200X
FLME 90693173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty