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General NPI Number Information
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NPI Number | 1699449462
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Entity Type | Organization
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Legal Business Name | 411 URGENT CARE LLC
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Dates
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Enumeration Date | 08/05/2021
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Last Update Date | 08/26/2021
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Provider Practice Location Address
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Address Line | 17820 SE 109TH AVE STE 108
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City | SUMMERFIELD
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State | FL
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Zip | 34491-8968
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Country | US
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Telephone | 352-547-9378
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Fax | 352-559-3939
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Provider Business Mailing Address
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Address Line | 17820 SE 109TH AVE STE 108
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City | SUMMERFIELD
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State | FL
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Zip | 34491-8968
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Country | US
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Telephone | 352-547-9378
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Fax | 352-559-3939
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Authorized Official
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Title or Position | MEDICAL / OFFICER
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Name | ADAMASTOR SANTOS
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Credential | PA
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Telephone | 352-274-4307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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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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