Provider Demographics
NPI:1356563829
Name:WINTER HAVEN INTENSIVE CARE CONSULTANTS PLLC
Entity type:Organization
Organization Name:WINTER HAVEN INTENSIVE CARE CONSULTANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:C
Authorized Official - Last Name:PALMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-867-8311
Mailing Address - Street 1:1511 SW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-4005
Mailing Address - Country:US
Mailing Address - Phone:352-867-8311
Mailing Address - Fax:352-867-1053
Practice Address - Street 1:200 AVENUE F NE
Practice Address - Street 2:ATTN: CHERYL PETTITT
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4131
Practice Address - Country:US
Practice Address - Phone:352-867-8311
Practice Address - Fax:352-867-1053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97772207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL33551OtherBCBS OF FLORIDA
FL33551OtherBCBS OF FLORIDA