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General NPI Number Information
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NPI Number | 1336498344
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Entity Type | Organization
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Legal Business Name | EMERGENCY CARE LLC
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Dates
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Enumeration Date | 09/05/2012
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Last Update Date | 04/11/2013
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Provider Practice Location Address
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Address Line | 141 AVENUE C SW SUITE 160
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City | WINTER HAVEN
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State | FL
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Zip | 33880-3258
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Country | US
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Telephone | 863-268-8259
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Fax |
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Provider Business Mailing Address
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Address Line | 2901 PLANTATION RD
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City | WINTER HAVEN
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State | FL
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Zip | 33884-1233
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Country | US
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Telephone | 407-791-1543
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DOUGLAS J RE
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Credential | PA
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Telephone | 407-791-1543
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9103254
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License Number State | FL
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