Provider Demographics
NPI:1053644906
Name:DOCS IN ERGENT CARE, LLC
Entity Type:Organization
Organization Name:DOCS IN ERGENT CARE, LLC
Other - Org Name:THE DOC'S IN ERGENT CARE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:DURSTEIN-DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-421-2512
Mailing Address - Street 1:210 NORTH HIGHWAY 27
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711
Mailing Address - Country:US
Mailing Address - Phone:407-421-2512
Mailing Address - Fax:
Practice Address - Street 1:210 NORTH HIGHWAY 27
Practice Address - Street 2:SUITE 4
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711
Practice Address - Country:US
Practice Address - Phone:407-421-2512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78446261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCJ161Medicare PIN
FLP00780028Medicare PIN