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General NPI Number Information
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NPI Number | 1295048270
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Entity Type | Organization
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Legal Business Name | FLORIDA IMMEDIATE CARE CENTERS LLC
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Dates
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Enumeration Date | 07/20/2010
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Last Update Date | 07/28/2010
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Provider Practice Location Address
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Address Line | 128 NW 137TH DR
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City | NEWBERRY
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State | FL
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Zip | 32669-0000
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Country | US
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Telephone | 352-258-4452
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Fax | 352-258-0088
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Provider Business Mailing Address
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Address Line | PO BOX 567
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City | LAKE BUTLER
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State | FL
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Zip | 32054-0567
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | PAUL CARLTON
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Credential |
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Telephone | 352-258-4452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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