Provider Demographics
NPI:1023326824
Name:ER URGENT CARE & DIAGNOSTIC, INC.
Entity type:Organization
Organization Name:ER URGENT CARE & DIAGNOSTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:EUGENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-581-1581
Mailing Address - Street 1:4141 NW 5TH ST
Mailing Address - Street 2:100
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2180
Mailing Address - Country:US
Mailing Address - Phone:954-581-1581
Mailing Address - Fax:954-581-0543
Practice Address - Street 1:4141 NW 5TH ST
Practice Address - Street 2:100
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2180
Practice Address - Country:US
Practice Address - Phone:954-581-1581
Practice Address - Fax:954-581-0543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9049111N00000X
FLME43064173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty