=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932368495
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 10 TO 10 URGENT CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2008
-----------------------------------------------------
Last Update Date | 07/09/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24420 STATE ROAD 54
-----------------------------------------------------
City | LUTZ
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33559-7303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-949-4100
-----------------------------------------------------
Fax | 813-949-4144
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24420 STATE ROAD 54
-----------------------------------------------------
City | LUTZ
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33559-7303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-949-4100
-----------------------------------------------------
Fax | 813-949-4144
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | MR. KENNETH COLEMAN RICE
-----------------------------------------------------
Credential | PA
-----------------------------------------------------
Telephone | 727-278-6806
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------