=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609117373
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALL-IN-ONE URGENT CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2013
-----------------------------------------------------
Last Update Date | 01/14/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 US HIGHWAY 27 N
-----------------------------------------------------
City | SEBRING
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33870-2132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-658-3991
-----------------------------------------------------
Fax | 863-314-6962
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 211 US HIGHWAY 27 N
-----------------------------------------------------
City | SEBRING
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33870-2132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-658-3991
-----------------------------------------------------
Fax | 863-314-6962
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ALEX ALEXANDER AGOSTINI-MIRANDA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 786-228-6498
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------