MEDICARE: ERGENT CARE FLORIDA 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

General Provider Information

NPI Number	:	1457910366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERGENT CARE FLORIDA LLC

Provider Business Mailing Address
First Line	:	PO BOX 24847
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32241-4847
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1799 S FEDERAL HWY
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33432-7412
Country	:	US
Telephone Number	:	561-347-7933
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK CAPUTO
Credential	:	MD
Telephone Number	:	918-527-7024

Provider Enumeration Date	:	06/13/2019
Last Update Date	:	06/13/2019

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