Healthcare Provider Details

I. General information

NPI: 1306367503
Provider Name (Legal Business Name): CARESPOT OF ORLANDO HSI URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 SOUTH AVALON PARK BLVD
ORLANDO FL
32828
US

IV. Provider business mailing address

10151 DEERWOOD PARK BLVD STE 200
JACKSONVILLE FL
32256-0566
US

V. Phone/Fax

Practice location:
  • Phone: 407-295-7557
  • Fax:
Mailing address:
  • Phone: 904-854-1545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: WEBSTER GOLINKIN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 919-550-0821