Healthcare Provider Details

I. General information

NPI: 1356563829
Provider Name (Legal Business Name): WINTER HAVEN INTENSIVE CARE CONSULTANTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 AVENUE F NE ATTN: CHERYL PETTITT
WINTER HAVEN FL
33881-4131
US

IV. Provider business mailing address

1511 SW 1ST AVE
OCALA FL
34474-4005
US

V. Phone/Fax

Practice location:
  • Phone: 352-867-8311
  • Fax: 352-867-1053
Mailing address:
  • Phone: 352-867-8311
  • Fax: 352-867-1053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME97772
License Number StateFL

VIII. Authorized Official

Name: DR. VINCENT C PALMIRE
Title or Position: OWNER
Credential: M.D.
Phone: 352-867-8311