Healthcare Provider Details

I. General information

NPI: 1053363036
Provider Name (Legal Business Name): MEDIQUICK URGENT CARE CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 06/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 OFFICE PARK DR
PALM COAST FL
32137-3808
US

IV. Provider business mailing address

6 OFFICE PARK DR
PALM COAST FL
32137-3808
US

V. Phone/Fax

Practice location:
  • Phone: 386-447-6615
  • Fax: 386-447-1266
Mailing address:
  • Phone: 386-447-6615
  • Fax: 386-447-1266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number800014401
License Number StateFL

VIII. Authorized Official

Name: ANN SHAW
Title or Position: OFFICE MANAGER
Credential:
Phone: 386-447-6615