Healthcare Provider Details

I. General information

NPI: 1801960950
Provider Name (Legal Business Name): FIRST CARE WINTER HAVEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 01/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 1ST STREET NORTH
WINTER HAVEN FL
33881
US

IV. Provider business mailing address

400 1ST NORTH
WINTER HAVEN FL
33881
US

V. Phone/Fax

Practice location:
  • Phone: 863-299-2420
  • Fax: 863-299-2460
Mailing address:
  • Phone: 863-299-2420
  • Fax: 863-299-2460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAMES K LEE
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 863-299-2420