Provider Demographics
NPI:1952357519
Name:EXPRESS CARE OF BELLEVIEW, LLC
Entity Type:Organization
Organization Name:EXPRESS CARE OF BELLEVIEW, LLC
Other - Org Name:EXPRESS CARE OF BELLEVIEW, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CRIMI
Authorized Official - Suffix:JR
Authorized Official - Credentials:PA
Authorized Official - Phone:352-427-8680
Mailing Address - Street 1:10762 SE US HWY 441
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-3805
Mailing Address - Country:US
Mailing Address - Phone:352-347-5225
Mailing Address - Fax:352-347-1073
Practice Address - Street 1:10762 S US HWY 441
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-3805
Practice Address - Country:US
Practice Address - Phone:352-347-5225
Practice Address - Fax:352-347-1073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC4346207Q00000X, 208000000X, 208D00000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45653OtherBLUE CROSS BLUE SHIELD FL
FL660070101Medicaid
FL660070100Medicaid
FL660070100Medicaid
FL660070101Medicaid