Healthcare Provider Details

I. General information

NPI: 1053407734
Provider Name (Legal Business Name): PUTHAM REDICARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6690 CRILL AVENUE
PALATKA FL
32177
US

IV. Provider business mailing address

6690 CRILL AVENUE
PALATKA FL
32177
US

V. Phone/Fax

Practice location:
  • Phone: 386-325-5955
  • Fax: 386-325-4818
Mailing address:
  • Phone: 386-325-5955
  • Fax: 386-325-4818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberME0022140
License Number StateFL

VIII. Authorized Official

Name: DR. A C MAIER
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 386-325-5955