Provider Demographics
NPI:1508031246
Name:ATLANTIC URGENT CARE PL
Entity Type:Organization
Organization Name:ATLANTIC URGENT CARE PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:VANN
Authorized Official - Last Name:BESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-871-0840
Mailing Address - Street 1:PO BOX 731677
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32173-1677
Mailing Address - Country:US
Mailing Address - Phone:386-871-0840
Mailing Address - Fax:
Practice Address - Street 1:870 DUNLAWTON AVENUE
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127
Practice Address - Country:US
Practice Address - Phone:386-871-0840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care