NPIMap

Organization Active NPI

Medfast Urgent Care Centers, LLC

  • Urgent Care Clinic/Center
  • Melbourne, FL
National Provider Identifier
1861022659
Registry record updated Jun 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
MEDFAST URGENT CARE CENTERS, LLC
Practice address
1532 N Harbor City Blvd
Melbourne, FL 32935-6533
Phone
(321) 802-3311
NPI assigned
Jan 21, 2020
Last updated
Jun 17, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
MEDFAST URGENT CARE CENTERS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 17, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Marilyn Stevens
Title
Director of Billing
Phone
(321) 751-7222

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X NU Primary

Addresses

Primary practice location

1532 N Harbor City Blvd
Melbourne, FL 32935-6533

Mailing address

PO Box 859745
Port Saint Lucie, FL 34985-9745
Phone (321) 751-7222

Other identifiers 1

IdentifierTypeStateIssuer
101594900MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL www.medfastcare.com

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2185633Medfast Urgent Care Centers LLC1532 N Harbor City Blvd, Melbourne, FL 32935Certificate of waiverJun 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Medfast Urgent Care Centers LLC20 organizations share this tax ID, including this one
Part of
Medfast Urgent Care Centers LLC

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1579564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592352000000",
    "number": "1861022659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 859745",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349859745",
            "telephone_number": "321-751-7222",
            "fax_number": "321-751-6655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1532 N HARBOR CITY BLVD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329356533",
            "telephone_number": "321-802-3311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDFAST URGENT CARE CENTERS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDFAST URGENT CARE CENTERS, LLC",
        "enumeration_date": "2020-01-21",
        "last_updated": "2020-06-17",
        "certification_date": "2020-06-17",
        "status": "A",
        "authorized_official_last_name": "STEVENS",
        "authorized_official_first_name": "MARILYN",
        "authorized_official_title_or_position": "DIRECTOR OF BILLING",
        "authorized_official_telephone_number": "321-751-7222"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101594900",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.medfastcare.com",
            "affiliation": "N",
            "address_1": "1532 N Harbor City Blvd",
            "city": "Melbourne",
            "state": "FL",
            "country_code": "US",
            "postal_code": "329356533",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.