Provider Demographics
NPI:1508042557
Name:PRIME URGENT CARE OF FLA LLC
Entity Type:Organization
Organization Name:PRIME URGENT CARE OF FLA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-637-6380
Mailing Address - Street 1:255 W END DR
Mailing Address - Street 2:UNIT 1309
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-5359
Mailing Address - Country:US
Mailing Address - Phone:941-637-6380
Mailing Address - Fax:
Practice Address - Street 1:290 NICHOLAS PKWY NW
Practice Address - Street 2:STE 1
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-3804
Practice Address - Country:US
Practice Address - Phone:941-637-6380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-20
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53510261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care