Organization
HEATHROW URGENT CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LANE R PHILLIPS D.O. (OWNER)
(407) 804-9494
Entity
Organization
Contact information
Practice address
1125 TOWNPARK AVE, SUITE 1011, LAKE MARY, FL 32746-4791
(407) 804-9494
(407) 804-9443
Mailing address
1125 TOWNPARK AVE, SUITE 1011, LAKE MARY, FL 32746-4791
(407) 804-9494
(407) 804-9443
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
329964
WELLCARE, STAYWELL, HEALTHEASE
FL
01
—
B906N
BLUE CROSS BLUE SHIELD
FL
Enumeration date
04/16/2007
Last updated
01/25/2013
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