Provider Demographics
NPI:1881970168
Name:DR GS URGENT CARE LLC
Entity type:Organization
Organization Name:DR GS URGENT CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MYLISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRABER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-296-2322
Mailing Address - Street 1:1425 S CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-6384
Mailing Address - Country:US
Mailing Address - Phone:561-330-9363
Mailing Address - Fax:561-431-3186
Practice Address - Street 1:1425 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6384
Practice Address - Country:US
Practice Address - Phone:561-330-9363
Practice Address - Fax:561-431-3186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82335261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care