Provider Demographics
NPI:1821280579
Name:ATLANTIS URGENT CARE, LLC
Entity Type:Organization
Organization Name:ATLANTIS URGENT CARE, LLC
Other - Org Name:ATLANTIS URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BJORN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-777-2273
Mailing Address - Street 1:2254 HIGHWAY A1A
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4922
Mailing Address - Country:US
Mailing Address - Phone:321-777-2273
Mailing Address - Fax:321-779-7425
Practice Address - Street 1:2254 HIGHWAY A1A
Practice Address - Street 2:
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-4922
Practice Address - Country:US
Practice Address - Phone:321-777-2273
Practice Address - Fax:321-779-7425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL602309261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4296OtherMEDICARE PROVIDER ID