Healthcare Provider Details

I. General information

NPI: 1770239162
Provider Name (Legal Business Name): SOS MOBILE MEDICAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16025 MUIRFIELD DR
ODESSA FL
33556-2861
US

IV. Provider business mailing address

PO BOX 22
ODESSA FL
33556-0022
US

V. Phone/Fax

Practice location:
  • Phone: 813-226-3332
  • Fax: 813-793-7644
Mailing address:
  • Phone: 813-226-3332
  • Fax: 813-793-7644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSHUA EDWARD KOLANKO
Title or Position: OWNER/NURSE PRACTITIONER
Credential: NP
Phone: 813-226-3332