MEDICARE: QUICK CARE MED, 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	332900000X	Non-Pharmacy Dispensing Site
2	208D00000X	General Practice Physician

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	:	1679135305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUICK CARE MED, LLC

Provider Business Mailing Address
First Line	:	PO BOX 2066
Second Line	:
City	:	LECANTO
State	:	FL
Zip	:	34460-2066
Country	:	US
Telephone Number	:	352-563-0931
Fax Number	:	352-563-0935

Provider Business Practice Location Address
First Line	:	3956 S SUNCOAST BLVD
Second Line	:
City	:	HOMOSASSA
State	:	FL
Zip	:	34448-2601
Country	:	US
Telephone Number	:	352-628-0911
Fax Number	:	352-503-9925

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	JEANETTE SMITH
Credential	:
Telephone Number	:	352-634-8736

Provider Enumeration Date	:	07/02/2019
Last Update Date	:	06/24/2021

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Directions to “QUICK CARE MED, LLC ” Practice Location

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