Provider Demographics
NPI:1952614489
Name:FLORIDA IMMEDIATE CARE CENTERS LLC
Entity Type:Organization
Organization Name:FLORIDA IMMEDIATE CARE CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-258-4452
Mailing Address - Street 1:PO BOX 567
Mailing Address - Street 2:
Mailing Address - City:LAKE BUTLER
Mailing Address - State:FL
Mailing Address - Zip Code:32054-0567
Mailing Address - Country:US
Mailing Address - Phone:352-258-4452
Mailing Address - Fax:352-258-0088
Practice Address - Street 1:128 NW 137TH DR
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669
Practice Address - Country:US
Practice Address - Phone:352-258-4452
Practice Address - Fax:352-258-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care