| |
5616 Tuscola Blvd North Port FL 34287-2738 | |
(941) 240-6273 | |
(941) 240-6428 |
Full Name | |
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Speciality | Clinic/center - Urgent Care |
Location | 5616 Tuscola Blvd, North Port, Florida |
Authorized Official Name and Position | Joy Kimball (CONTRACT MANAGER) |
Authorized Official Contact | 7633496740 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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423 Fortress Blvd Morgantown WV 26508-1351 Ph: (304) 225-2500 | 5616 Tuscola Blvd North Port FL 34287-2738 Ph: (941) 240-6273 |
NPI Number | 1871941815 |
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Provider Enumeration Date | 06/01/2016 |
Last Update Date | 05/07/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1871941815 | NPI | - | NPPES |
018546900 | Medicaid | FL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | (* (Not Available)) | Secondary |
261QU0200X | Clinic/center - Urgent Care | (* (Not Available)) | Primary |
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