Provider Demographics
NPI:1205225679
Name:SUPER URGENT CARE LLC
Entity Type:Organization
Organization Name:SUPER URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP
Authorized Official - Prefix:MR
Authorized Official - First Name:SRIRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNDARAMOORTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-274-9900
Mailing Address - Street 1:1414 SW MARTIN LUTHER KING JR AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0529
Mailing Address - Country:US
Mailing Address - Phone:352-274-9900
Mailing Address - Fax:800-985-9168
Practice Address - Street 1:1714 SW 17TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-1223
Practice Address - Country:US
Practice Address - Phone:352-274-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care