Healthcare Provider Details

I. General information

NPI: 1639445596
Provider Name (Legal Business Name): APPLE URGENT CARES, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 03/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 EAST MOODY BLVD
BUNNELL FL
32110-5916
US

IV. Provider business mailing address

1400 E MOODY BLVD
BUNNELL FL
32110-5916
US

V. Phone/Fax

Practice location:
  • Phone: 386-313-2599
  • Fax: 386-313-2577
Mailing address:
  • Phone: 386-313-2599
  • Fax: 386-313-2577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH9168
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberOS10016
License Number StateFL

VIII. Authorized Official

Name: DR. ROY C CARLISI
Title or Position: MGRM
Credential: D.C.
Phone: 386-237-4003