=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356563829
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WINTER HAVEN INTENSIVE CARE CONSULTANTS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2007
-----------------------------------------------------
Last Update Date | 10/15/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 AVENUE F NE ATTN: CHERYL PETTITT
-----------------------------------------------------
City | WINTER HAVEN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33881-4131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-867-8311
-----------------------------------------------------
Fax | 352-867-1053
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1511 SW 1ST AVE
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34474-4005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-867-8311
-----------------------------------------------------
Fax | 352-867-1053
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. VINCENT C PALMIRE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 352-867-8311
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | ME97772
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------