Provider Demographics
NPI:1609231737
Name:MEDFAST URGENT CARE CENTERS,LLC
Entity Type:Organization
Organization Name:MEDFAST URGENT CARE CENTERS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-802-3311
Mailing Address - Street 1:206 E NEW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-4504
Mailing Address - Country:US
Mailing Address - Phone:321-821-4950
Mailing Address - Fax:321-821-4955
Practice Address - Street 1:206 E NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4504
Practice Address - Country:US
Practice Address - Phone:321-751-7222
Practice Address - Fax:321-751-6655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-16
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care