Healthcare Provider Details

I. General information

NPI: 1801125331
Provider Name (Legal Business Name): THSE - MARCO URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2009
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 S HEATHWOOD DR
MARCO ISLAND FL
34145-5026
US

IV. Provider business mailing address

1643 NW 136TH AVE STE 100
SUNRISE FL
33323-2857
US

V. Phone/Fax

Practice location:
  • Phone: 239-394-8234
  • Fax:
Mailing address:
  • Phone: 800-424-3672
  • Fax: 954-377-3042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL D CORVINI
Title or Position: PRESIDENT
Credential: MD
Phone: 800-424-3672