Provider Demographics
NPI:1902107030
Name:FLORIDA REGIONAL URGENT CARE
Entity Type:Organization
Organization Name:FLORIDA REGIONAL URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-807-1621
Mailing Address - Street 1:1040 71ST ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-2972
Mailing Address - Country:US
Mailing Address - Phone:305-866-6665
Mailing Address - Fax:
Practice Address - Street 1:1040 71ST ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-2972
Practice Address - Country:US
Practice Address - Phone:305-866-6665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRL10003739261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care