Provider Demographics
NPI:1861022659
Name:MEDFAST URGENT CARE CENTERS, LLC
Entity type:Organization
Organization Name:MEDFAST URGENT CARE CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-751-7222
Mailing Address - Street 1:PO BOX 859745
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34985-9745
Mailing Address - Country:US
Mailing Address - Phone:321-751-7222
Mailing Address - Fax:321-751-6655
Practice Address - Street 1:1532 N HARBOR CITY BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-6533
Practice Address - Country:US
Practice Address - Phone:321-802-3311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDFAST URGENT CARE CENTERS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-21
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101594900Medicaid