Provider Demographics
NPI:1891113064
Name:MERCY MEDICAL URGENT CARE CENTER
Entity Type:Organization
Organization Name:MERCY MEDICAL URGENT CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-758-2944
Mailing Address - Street 1:2786 W US HIGHWAY 90 STE 105
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-7723
Mailing Address - Country:US
Mailing Address - Phone:386-758-2944
Mailing Address - Fax:386-758-9822
Practice Address - Street 1:2786 W US HIGHWAY 90 STE 105
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-7723
Practice Address - Country:US
Practice Address - Phone:386-758-2944
Practice Address - Fax:386-758-9822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013907900Medicaid
FLB90PPOtherBCBS
FLHV654AMedicare UPIN