Healthcare Provider Details

I. General information

NPI: 1831142389
Provider Name (Legal Business Name): EXPRESS CARE OF BELLEVIEW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 CITRUS BLVD.
LEESBURG FL
34748-3063
US

IV. Provider business mailing address

10762 SE US HWY 441
BELLEVIEW FL
34420-3805
US

V. Phone/Fax

Practice location:
  • Phone: 352-728-2828
  • Fax: 352-315-3837
Mailing address:
  • Phone: 352-347-5225
  • Fax: 352-347-1073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberHC6883
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberHCC6883
License Number StateFL

VIII. Authorized Official

Name: MR. MICHAEL CRIMI JR.
Title or Position: PRESIDENT / CEO / OWNER
Credential: P.A.
Phone: 352-427-8680