Provider Demographics
NPI:1891956397
Name:PARAMOUNT URGENT CARE INC
Entity Type:Organization
Organization Name:PARAMOUNT URGENT CARE INC
Other - Org Name:PARAMOUNT URGENT CARE INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:HUMPHREY
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:352-674-9218
Mailing Address - Street 1:805 E CR 466
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-0000
Mailing Address - Country:US
Mailing Address - Phone:352-674-9218
Mailing Address - Fax:352-259-6069
Practice Address - Street 1:805 E CR 466
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-0000
Practice Address - Country:US
Practice Address - Phone:352-674-9218
Practice Address - Fax:352-259-6069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81076261QM1300X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061502100Medicaid
FL98811ROtherMEDICARE UNSPECIFIC
FL92811OtherBCBS
FLAO108Medicare PIN
FL92811OtherBCBS
FL98811ROtherMEDICARE UNSPECIFIC