Provider Demographics
NPI:1891404877
Name:VIVAGEN HEALTH URGENT CARE
Entity type:Organization
Organization Name:VIVAGEN HEALTH URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:G
Authorized Official - Last Name:CAMP
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:954-440-6468
Mailing Address - Street 1:8240 PINES BLVD # B
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6712
Mailing Address - Country:US
Mailing Address - Phone:954-440-6468
Mailing Address - Fax:
Practice Address - Street 1:8240 PINES BLVD # B
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6712
Practice Address - Country:US
Practice Address - Phone:954-440-6468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIVAGEN HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-18
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115105400Medicaid