Provider Demographics
NPI:1700200813
Name:URGENT CARE BAPTIST C CORP
Entity Type:Organization
Organization Name:URGENT CARE BAPTIST C CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:J
Authorized Official - Last Name:MATAMOROS
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:305-503-6115
Mailing Address - Street 1:14750 SW 26TH STREET
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185
Mailing Address - Country:US
Mailing Address - Phone:305-503-6115
Mailing Address - Fax:
Practice Address - Street 1:14750 SW 26TH STREET
Practice Address - Street 2:SUITE 216
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185
Practice Address - Country:US
Practice Address - Phone:305-503-6115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:URGENT CARE BAPTIST C CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME38894261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center