ISLAND CITY URGENT CARE

Provider Demographics

• NPI: 1003647587
• Name: ISLAND CITY URGENT CARE
• Entity type: Organization
• Organization Name: ISLAND CITY URGENT CARE
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: OWNER
• Authorized Official - First Name: KYLE
• Authorized Official - Middle Name: JAMES
• Authorized Official - Last Name: OLEARY
• Authorized Official - Credentials: APRN
• Authorized Official - Phone: 954-391-7160
• Mailing Address - Street 1: 1442 NE 26TH ST
• Mailing Address - City: WILTON MANORS
• Mailing Address - State: FL
• Mailing Address - Zip Code: 33305-1322
• Mailing Address - Country: US
• Mailing Address - Phone: 954-391-7160
• Mailing Address - Fax: 954-393-0811
• Practice Address - Street 1: 1442 NE 26TH ST
• Practice Address - City: WILTON MANORS
• Practice Address - State: FL
• Practice Address - Zip Code: 33305-1322
• Practice Address - Country: US
• Practice Address - Phone: 954-391-7160
• Practice Address - Fax: 954-393-0811
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2024-08-08
• Last Update Date: 2025-10-13
• Deactivation Date: 2025-08-19
• Reactivation Date: 2025-10-13

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	261QM1300X	Ambulatory Health Care Facilities	Clinic/Center	Multi-Specialty
No	363LP2300X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Primary Care	Group - Multi-Specialty
No	261QX0100X	Ambulatory Health Care Facilities	Clinic/Center	Occupational Medicine
No	261QR0200X	Ambulatory Health Care Facilities	Clinic/Center	Radiology
No	261QU0200X	Ambulatory Health Care Facilities	Clinic/Center	Urgent Care
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty
No	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies
No	332900000X	Suppliers	Non-Pharmacy Dispensing Site
No	261QS1000X	Ambulatory Health Care Facilities	Clinic/Center	Student Health
No	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty
No	3336C0002X	Suppliers	Pharmacy	Clinic Pharmacy
No	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Family	Group - Multi-Specialty
No	363LX0106X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Occupational Health	Group - Multi-Specialty
No	207ZP0105X	Allopathic & Osteopathic Physicians	Pathology	Clinical Pathology/Laboratory Medicine	Group - Multi-Specialty
No	305S00000X	Managed Care Organizations	Point of Service

Provider Identifiers

State	Identifier ID	ID Type	Issuer
FL	11021418	Other	APRN
FL	1245103449	Other	NPI
FL	JR5657900	Other	RADIOLOGYXRAY
FL	TU149	Medicaid
FL	1417679762	Other	NPI
FL	82907	Other	PHARMACY
FL	TU148	Medicaid