Provider Demographics
NPI:1639178510
Name:MELBOURNE URGENT CARE, LLC
Entity Type:Organization
Organization Name:MELBOURNE URGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:VARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-953-9981
Mailing Address - Street 1:187 S WICKHAM RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-1123
Mailing Address - Country:US
Mailing Address - Phone:321-953-9981
Mailing Address - Fax:321-953-0212
Practice Address - Street 1:187 S WICKHAM RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-1123
Practice Address - Country:US
Practice Address - Phone:321-953-9981
Practice Address - Fax:321-953-0212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88505261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center