Provider Demographics
NPI:1649665902
Name:PHYSICIANS IMMEDIATE CARE NORTH, LLC
Entity type:Organization
Organization Name:PHYSICIANS IMMEDIATE CARE NORTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PALESTRANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-343-1776
Mailing Address - Street 1:5550 S US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-8701
Mailing Address - Country:US
Mailing Address - Phone:772-460-9227
Mailing Address - Fax:772-460-9292
Practice Address - Street 1:5550 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-8701
Practice Address - Country:US
Practice Address - Phone:772-460-9227
Practice Address - Fax:772-460-9292
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICIANS IMMEDIATE CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-03
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7482261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care