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General NPI Number Information
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NPI Number | 1700898467
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Entity Type | Organization
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Legal Business Name | EXCEPTIONAL URGENT CARE CENTER I INC
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 01/15/2009
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Provider Practice Location Address
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Address Line | 11950 COUNTY ROAD 101 SUITE #101
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City | THE VILLAGES
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State | FL
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Zip | 32162-9332
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Country | US
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Telephone | 352-391-5200
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Fax | 352-391-5903
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Provider Business Mailing Address
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Address Line | 11950 COUNTY ROAD 101 SUITE #101
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City | THE VILLAGES
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State | FL
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Zip | 32162-9332
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Country | US
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Telephone | 352-391-5200
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Fax | 352-391-5903
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JOHN JOSEPH IM
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Credential | D.O.
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Telephone | 352-391-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | OS8729
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License Number State | FL
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