Provider Demographics
NPI:1831869452
Name:PALMETTO URGENT CARE, LLC
Entity type:Organization
Organization Name:PALMETTO URGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAVIA
Authorized Official - Suffix:
Authorized Official - Credentials:MAT, LAT, ATC
Authorized Official - Phone:941-212-7125
Mailing Address - Street 1:4321 HOLLOW STUMP RUN
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-1250
Mailing Address - Country:US
Mailing Address - Phone:941-212-7125
Mailing Address - Fax:
Practice Address - Street 1:4321 HOLLOW STUMP RUN
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-1250
Practice Address - Country:US
Practice Address - Phone:941-212-7125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care