Provider Demographics
NPI:1578125209
Name:QUICK CARE MED, LLC
Entity Type:Organization
Organization Name:QUICK CARE MED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLEY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BALBUENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-513-9265
Mailing Address - Street 1:PO BOX 2066
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34460-2066
Mailing Address - Country:US
Mailing Address - Phone:352-563-0931
Mailing Address - Fax:352-563-0935
Practice Address - Street 1:11371 N WILLIAMS ST STE 4
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34432-8362
Practice Address - Country:US
Practice Address - Phone:352-465-2273
Practice Address - Fax:352-465-6343
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUICK CARE MED LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-02
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003672402Medicaid