MEDICARE: NEW SMYRNA BEACH URGENT 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	146N00000X	Basic Emergency Medical Technician		FL

General Provider Information

NPI Number	:	1801126297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW SMYRNA BEACH URGENT CARE, LLC

Provider Business Mailing Address
First Line	:	1860 RENZULLI RD
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-1726
Country	:	US
Telephone Number	:	386-663-3061
Fax Number	:	386-663-3066

Provider Business Practice Location Address
First Line	:	1860 RENZULLI ROAD
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-1726
Country	:	US
Telephone Number	:	386-663-3061
Fax Number	:	386-663-3066

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MS. ERIN C MAXWELL
Credential	:	PA
Telephone Number	:	386-663-3061

Provider Enumeration Date	:	01/06/2010
Last Update Date	:	07/21/2022

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