MEDICARE: 1ST CARE 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	PAX9107242	FL

General Provider Information

NPI Number	:	1578988002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1ST CARE LLC

Provider Business Mailing Address
First Line	:	4401 N FEDERAL HWY
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33308-5201
Country	:	US
Telephone Number	:	954-815-6340
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 N FEDERAL HWY
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33308-5201
Country	:	US
Telephone Number	:	954-815-6340
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GREGORY PITTMAN
Credential	:
Telephone Number	:	954-815-6340

Provider Enumeration Date	:	02/20/2014
Last Update Date	:	02/20/2014

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