Provider Demographics
NPI:1245712603
Name:PALM COAST URGENT CARE
Entity type:Organization
Organization Name:PALM COAST URGENT CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RODNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-250-4354
Mailing Address - Street 1:3288 SILVER STAR RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836
Mailing Address - Country:US
Mailing Address - Phone:407-250-4354
Mailing Address - Fax:407-250-4354
Practice Address - Street 1:6388 SILVER STAR RD SUITE 1C
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818
Practice Address - Country:US
Practice Address - Phone:407-250-4354
Practice Address - Fax:407-250-4354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-02
Last Update Date:2018-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty