1013389501 NPI number — PARAMOUNT URGENT CARE INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013389501 NPI number — PARAMOUNT URGENT CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARAMOUNT URGENT CARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013389501
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
805 E COUNTY ROAD 466
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LADY LAKE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-674-9218
Provider Business Mailing Address Fax Number:
352-259-6069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1984 ALAFAYA TRL
Provider Second Line Business Practice Location Address:
SUITE 1000
Provider Business Practice Location Address City Name:
OVIEDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32765-4524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-542-0346
Provider Business Practice Location Address Fax Number:
352-674-9218
Provider Enumeration Date:
10/23/2015

Additional Information

Authorized Official

Authorized Official Last Name:
EASTERLING
Authorized Official First Name:
ADRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
407-542-0346

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  PA9104065 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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