Provider Demographics
NPI:1801126297
Name:NEW SMYRNA BEACH URGENT CARE, LLC
Entity type:Organization
Organization Name:NEW SMYRNA BEACH URGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:386-663-3061
Mailing Address - Street 1:1860 RENZULLI RD
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-1726
Mailing Address - Country:US
Mailing Address - Phone:386-663-3061
Mailing Address - Fax:386-663-3066
Practice Address - Street 1:1860 RENZULLI ROAD
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-1726
Practice Address - Country:US
Practice Address - Phone:386-663-3061
Practice Address - Fax:386-663-3066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCX503AMedicare PIN