Provider Demographics
NPI:1770824534
Name:COMPASSION PEDIATRIC URGENT CARE LLC
Entity Type:Organization
Organization Name:COMPASSION PEDIATRIC URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:BOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-985-1905
Mailing Address - Street 1:4445 S. SEMORAN BOULEVARD SUITE C
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822
Mailing Address - Country:US
Mailing Address - Phone:407-985-1905
Mailing Address - Fax:
Practice Address - Street 1:4445 S SEMORAN BLVD STE C
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-2472
Practice Address - Country:US
Practice Address - Phone:407-985-1905
Practice Address - Fax:407-985-1904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-04
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207PP0204X, 363AM0700X, 363LF0000X, 363LP0200X
FLME 110633261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101675700Medicaid