Provider Demographics
NPI:1609097674
Name:QUICKCARE OF CAPE CORAL INC
Entity Type:Organization
Organization Name:QUICKCARE OF CAPE CORAL INC
Other - Org Name:QUICKCARE EMERGENCY WALK IN CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER MED DIR
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:TANNENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-549-2772
Mailing Address - Street 1:515 CAPE CORAL
Mailing Address - Street 2:PKWY E
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-8545
Mailing Address - Country:US
Mailing Address - Phone:239-549-2772
Mailing Address - Fax:239-549-2332
Practice Address - Street 1:515 CAPE CORAL
Practice Address - Street 2:PKWY E
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-8545
Practice Address - Country:US
Practice Address - Phone:239-549-2772
Practice Address - Fax:239-549-2332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherEIN