Provider Demographics
NPI:1952311458
Name:INTERGOLD LLC
Entity Type:Organization
Organization Name:INTERGOLD LLC
Other - Org Name:INDIAN RIVER WALK IN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:LOBEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-795-4565
Mailing Address - Street 1:652 21ST ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-0937
Mailing Address - Country:US
Mailing Address - Phone:772-299-1092
Mailing Address - Fax:772-978-1960
Practice Address - Street 1:652 21ST ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-0937
Practice Address - Country:US
Practice Address - Phone:772-299-1092
Practice Address - Fax:772-978-1960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7190261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care