Provider Demographics
NPI:1205258910
Name:FLORIDA URGENT & FAMILY CARE P A
Entity type:Organization
Organization Name:FLORIDA URGENT & FAMILY CARE P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:L
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-837-8317
Mailing Address - Street 1:PO BOX 5399
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-5399
Mailing Address - Country:US
Mailing Address - Phone:850-687-9863
Mailing Address - Fax:
Practice Address - Street 1:4400 E HIGHWAY 20
Practice Address - Street 2:STE 209
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-8779
Practice Address - Country:US
Practice Address - Phone:850-687-9863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102584261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care