Provider Demographics
NPI:1700898467
Name:EXCEPTIONAL URGENT CARE CENTER I INC
Entity Type:Organization
Organization Name:EXCEPTIONAL URGENT CARE CENTER I INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:IM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-391-5200
Mailing Address - Street 1:11950 COUNTY ROAD 101
Mailing Address - Street 2:SUITE #101
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-9332
Mailing Address - Country:US
Mailing Address - Phone:352-391-5200
Mailing Address - Fax:352-391-5903
Practice Address - Street 1:11950 COUNTY ROAD 101
Practice Address - Street 2:SUITE #101
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-9332
Practice Address - Country:US
Practice Address - Phone:352-391-5200
Practice Address - Fax:352-391-5903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8729261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265844500Medicaid
FLB903SMedicare PIN
FL265844500Medicaid