Provider Demographics
NPI:1205307311
Name:WILTON MANORS URGENT CARE & DIAGNOSTIC
Entity type:Organization
Organization Name:WILTON MANORS URGENT CARE & DIAGNOSTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-533-8050
Mailing Address - Street 1:800 W OAKLAND PARK BLVD # 212217
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33311-0916
Mailing Address - Country:US
Mailing Address - Phone:954-533-8050
Mailing Address - Fax:954-990-5103
Practice Address - Street 1:800 W OAKLAND PARK BLVD # 212217
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33311-0916
Practice Address - Country:US
Practice Address - Phone:954-533-8050
Practice Address - Fax:954-990-5103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty