Provider Demographics
NPI:1972796837
Name:URGENT CARE AMERICA LLC
Entity type:Organization
Organization Name:URGENT CARE AMERICA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HASH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:850-766-3835
Mailing Address - Street 1:PO BOX 15853
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5853
Mailing Address - Country:US
Mailing Address - Phone:850-766-3835
Mailing Address - Fax:
Practice Address - Street 1:1554 SURGEONS DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4631
Practice Address - Country:US
Practice Address - Phone:850-766-3835
Practice Address - Fax:229-249-9771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 7744207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268637600Medicaid
FLAL205OtherMEDICARE PTAN
FLAL205OtherMEDICARE PTAN