Provider Demographics
NPI:1699072371
Name:LAKEWOOD RANCH URGENT CARE, PA
Entity type:Organization
Organization Name:LAKEWOOD RANCH URGENT CARE, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLKENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-447-5854
Mailing Address - Street 1:7322 MANATEE AVE W #108
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209
Mailing Address - Country:US
Mailing Address - Phone:941-447-5854
Mailing Address - Fax:
Practice Address - Street 1:6272 LAKE OSPREY DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-8425
Practice Address - Country:US
Practice Address - Phone:941-907-2800
Practice Address - Fax:941-907-9434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91466261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care