Provider Demographics
NPI:1184046393
Name:OCEAN MEDICAL WALK-IN CLINIC
Entity type:Organization
Organization Name:OCEAN MEDICAL WALK-IN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:RODAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-771-4000
Mailing Address - Street 1:4001 N OCEAN DR STE 105
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE BY THE SEA
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5968
Mailing Address - Country:US
Mailing Address - Phone:954-771-4000
Mailing Address - Fax:
Practice Address - Street 1:4001 N OCEAN DR STE 105
Practice Address - Street 2:
Practice Address - City:LAUDERDALE BY THE SEA
Practice Address - State:FL
Practice Address - Zip Code:33308-5968
Practice Address - Country:US
Practice Address - Phone:954-771-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9100841364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty