Provider Demographics
NPI:1336498344
Name:EMERGENCY CARE LLC
Entity Type:Organization
Organization Name:EMERGENCY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:RE
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:407-791-1543
Mailing Address - Street 1:2901 PLANTATION RD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-1233
Mailing Address - Country:US
Mailing Address - Phone:407-791-1543
Mailing Address - Fax:
Practice Address - Street 1:141 AVENUE C SW
Practice Address - Street 2:SUITE 160
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3258
Practice Address - Country:US
Practice Address - Phone:863-268-8259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9103254363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ44344Medicaid