Provider Demographics
NPI:1720439557
Name:MEDPRO URGENT CARE CENTER, INC
Entity type:Organization
Organization Name:MEDPRO URGENT CARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANETA
Authorized Official - Middle Name:
Authorized Official - Last Name:DADASHEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-924-6151
Mailing Address - Street 1:2950 GRIFFIN RD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-5648
Mailing Address - Country:US
Mailing Address - Phone:954-924-6151
Mailing Address - Fax:
Practice Address - Street 1:2950 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-5648
Practice Address - Country:US
Practice Address - Phone:954-924-6151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-22
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10911207QA0505X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1942335492OtherNPI