Provider Demographics
NPI:1982880613
Name:PINE CASTLE URGENT CARE CENTER PLLC
Entity Type:Organization
Organization Name:PINE CASTLE URGENT CARE CENTER PLLC
Other - Org Name:AMERICAS URGENT CARE OF PINE CASTLE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:NINO
Authorized Official - Middle Name:
Authorized Official - Last Name:DIIULLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-880-5340
Mailing Address - Street 1:5636 HANSEL AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-4216
Mailing Address - Country:US
Mailing Address - Phone:407-850-0056
Mailing Address - Fax:
Practice Address - Street 1:5636 HANSEL AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4216
Practice Address - Country:US
Practice Address - Phone:407-850-0056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center