Provider Demographics
NPI:1487160701
Name:XPRESS URGENT CARE LLC
Entity type:Organization
Organization Name:XPRESS URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAZIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHIKARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-779-1652
Mailing Address - Street 1:PO BOX 4189
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-4189
Mailing Address - Country:US
Mailing Address - Phone:561-779-1652
Mailing Address - Fax:
Practice Address - Street 1:3387 S JOG RD STE 103
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33467-2010
Practice Address - Country:US
Practice Address - Phone:561-781-8090
Practice Address - Fax:561-781-8099
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:XPRESS URGENT CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-22
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008195612Medicaid