1588958342 NPI number — COMPLETE URGENT HEALTHCARE LLC

Table of content: (NPI 1588958342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588958342 NPI number — COMPLETE URGENT HEALTHCARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPLETE URGENT HEALTHCARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588958342
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20665 LYONS RD
Provider Second Line Business Mailing Address:
#A3
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33434-3947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-309-7815
Provider Business Mailing Address Fax Number:
561-640-9282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2517 SEMINOLE CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33409-7460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-309-7815
Provider Business Practice Location Address Fax Number:
516-640-9282
Provider Enumeration Date:
06/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDSTEIN
Authorized Official First Name:
EVAN
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
561-309-7815

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , with the licence number:  ME0064033 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com