Provider Demographics
NPI:1952796112
Name:PHYSICIANS IMMEDIATE CARE JENSEN BEACH, LLC
Entity Type:Organization
Organization Name:PHYSICIANS IMMEDIATE CARE JENSEN BEACH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PALESTRANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-343-1776
Mailing Address - Street 1:1801 NE JENSEN BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-7233
Mailing Address - Country:US
Mailing Address - Phone:772-334-1700
Mailing Address - Fax:772-334-1701
Practice Address - Street 1:1801 NE JENSEN BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-7233
Practice Address - Country:US
Practice Address - Phone:772-334-1700
Practice Address - Fax:772-334-1701
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICIANS IMMEDIATE CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-03
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC10747261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care