Healthcare Provider Details

I. General information

NPI: 1770824534
Provider Name (Legal Business Name): COMPASSION PEDIATRIC URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 S SEMORAN BLVD STE C
ORLANDO FL
32822-2472
US

IV. Provider business mailing address

4445 S. SEMORAN BOULEVARD SUITE C
ORLANDO FL
32822
US

V. Phone/Fax

Practice location:
  • Phone: 407-985-1905
  • Fax: 407-985-1904
Mailing address:
  • Phone: 407-985-1905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberME 110633
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LESLEY KYLE BOW
Title or Position: PRESIDENT
Credential: M.D.
Phone: 407-985-1905