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NPI Code Detail

MEDICARE: PHYSICIANS IMMEDIATE CARE JENSEN BEACH, LLC

MEDICARE: PHYSICIANS IMMEDIATE CARE JENSEN BEACH, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QU0200XUrgent Care Clinic/CenterHCC10747FL

General Provider Information

NPI Number : 1952796112
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHYSICIANS IMMEDIATE CARE JENSEN BEACH, LLC
Provider Business Mailing Address
First Line : 1801 NE JENSEN BEACH BLVD
Second Line :
City : JENSEN BEACH
State : FL
Zip : 34957-7233
Country : US
Telephone Number : 772-334-1700
Fax Number : 772-334-1701
Provider Business Practice Location Address
First Line : 1801 NE JENSEN BEACH BLVD
Second Line :
City : JENSEN BEACH
State : FL
Zip : 34957-7233
Country : US
Telephone Number : 772-334-1700
Fax Number : 772-334-1701
Authorized Official
Title or Position : CEO
Name : KENNETH PALESTRANT
Credential : M.D.
Telephone Number : 772-343-1776
Provider Enumeration Date : 04/03/2015
Last Update Date : 04/07/2015

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