MEDICARE: CLINIC OF PLANT CITY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center	9280973	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417336413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINIC OF PLANT CITY, LLC

Provider Business Mailing Address
First Line	:	802 W MARTIN LUTHER KING BLVD
Second Line	:	SUITE A
City	:	PLANT CITY
State	:	FL
Zip	:	33563-5105
Country	:	US
Telephone Number	:	813-754-7999
Fax Number	:	813-754-7111

Provider Business Practice Location Address
First Line	:	802 W MARTIN LUTHER KING BLVD
Second Line	:	SUITE A
City	:	PLANT CITY
State	:	FL
Zip	:	33563-5105
Country	:	US
Telephone Number	:	813-754-7999
Fax Number	:	813-754-7111

Authorized Official
Title or Position	:	OWNER
Name	:	GINGER SINGLETARY
Credential	:	ARNP
Telephone Number	:	813-754-7999

Provider Enumeration Date	:	05/22/2015
Last Update Date	:	06/29/2016

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Directions to “CLINIC OF PLANT CITY, LLC ” Practice Location

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