Provider Demographics
NPI:1639498744
Name:PALM HARBOR/OLDSMAR URGENT CARE CORPORATION
Entity Type:Organization
Organization Name:PALM HARBOR/OLDSMAR URGENT CARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYSZARD
Authorized Official - Middle Name:IGNACY
Authorized Official - Last Name:KASZUBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-488-7484
Mailing Address - Street 1:1644 LAGO VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-3353
Mailing Address - Country:US
Mailing Address - Phone:727-488-7484
Mailing Address - Fax:
Practice Address - Street 1:3180 CURLEW RD
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-2606
Practice Address - Country:US
Practice Address - Phone:727-488-7484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service