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NPI Code Detail

MEDICARE: PHYSICIANS IMMEDIATE CARE NORTH, LLC

MEDICARE: PHYSICIANS IMMEDIATE CARE NORTH, 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
1261QU0200XUrgent Care Clinic/CenterHCC7482FL

General Provider Information

NPI Number : 1649665902
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHYSICIANS IMMEDIATE CARE NORTH, LLC
Provider Business Mailing Address
First Line : 5550 S US HIGHWAY 1
Second Line :
City : FORT PIERCE
State : FL
Zip : 34982-8701
Country : US
Telephone Number : 772-460-9227
Fax Number : 772-460-9292
Provider Business Practice Location Address
First Line : 5550 S US HIGHWAY 1
Second Line :
City : FORT PIERCE
State : FL
Zip : 34982-8701
Country : US
Telephone Number : 772-460-9227
Fax Number : 772-460-9292
Authorized Official
Title or Position : CEO
Name : KENNETH PALESTRANT
Credential : M.D.
Telephone Number : 772-343-1776
Provider Enumeration Date : 04/03/2015
Last Update Date : 04/07/2015

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Directions to “PHYSICIANS IMMEDIATE CARE NORTH, LLC ” Practice Location

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