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General NPI Number Information
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NPI Number | 1881015477
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Entity Type | Organization
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Legal Business Name | NICEVILLE URGENT CARE LLC
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Dates
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Enumeration Date | 12/27/2013
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Last Update Date | 12/27/2013
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Provider Practice Location Address
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Address Line | 910 PALM BLVD S
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City | NICEVILLE
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State | FL
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Zip | 32578-2603
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Country | US
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Telephone | 850-398-8077
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Fax |
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Provider Business Mailing Address
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Address Line | 910 PALM BLVD S
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City | NICEVILLE
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State | FL
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Zip | 32578-2603
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | CHARLIE CLANCY
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Credential | PA-C
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Telephone | 850-515-1174
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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 |
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License Number State |
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