Provider Demographics
NPI:1811408396
Name:BAYCARE URGENT CARE, LLC
Entity Type:Organization
Organization Name:BAYCARE URGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, PFS
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GORKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-281-9390
Mailing Address - Street 1:2995 DREW ST FL 2
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:727-281-9390
Mailing Address - Fax:813-635-2613
Practice Address - Street 1:400 1ST ST N
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4115
Practice Address - Country:US
Practice Address - Phone:863-299-2420
Practice Address - Fax:866-229-7558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-24
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274807000Medicaid