Provider Demographics
NPI:1225620156
Name:441 URGENT CARE CENTER, LLC
Entity Type:Organization
Organization Name:441 URGENT CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAMASTOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-693-2340
Mailing Address - Street 1:17820 SE 109TH AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-8968
Mailing Address - Country:US
Mailing Address - Phone:352-693-2340
Mailing Address - Fax:
Practice Address - Street 1:4669 E SR 44 STE 101
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785-7460
Practice Address - Country:US
Practice Address - Phone:352-693-2340
Practice Address - Fax:352-693-2345
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:441 URGENT CARE CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care