Provider Demographics
NPI:1174743744
Name:LAS OLAS URGENT CARE
Entity type:Organization
Organization Name:LAS OLAS URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARZON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-763-1230
Mailing Address - Street 1:2607 NE 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33334-3707
Mailing Address - Country:US
Mailing Address - Phone:954-763-1230
Mailing Address - Fax:
Practice Address - Street 1:2607 NE 10TH AVE
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33334-3707
Practice Address - Country:US
Practice Address - Phone:954-763-1230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty