1245103449 NPI number — ISLAND CITY URGENT CARE PA

Table of content: (NPI 1245103449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245103449 NPI number — ISLAND CITY URGENT CARE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ISLAND CITY URGENT CARE PA
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:
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:
1245103449
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1442 NE 26TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILTON MANORS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33305-1322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-391-7160
Provider Business Mailing Address Fax Number:
954-393-0811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1442 NE 26TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILTON MANORS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33305-1322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-391-7160
Provider Business Practice Location Address Fax Number:
954-393-0811
Provider Enumeration Date:
09/25/2025

Additional Information

Authorized Official

Authorized Official Last Name:
OLEARY
Authorized Official First Name:
KYLE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
APRN/OWNER
Authorized Official Telephone Number:
954-391-7160

Provider Taxonomy Codes

  • Taxonomy code: 2471S1302X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QX0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2083X0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QS1000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 305S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: JR5657900 . This is a "XRAY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 82907 . This is a "PHARMACY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1003647587 . This is a "NPI-GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 11021418 . This is a "APRN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 15988989 . This is a "CAHQ" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: ALA . This is a "FLORIDABLUE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 124809600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10D2317428 . This is a "CLIA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1417679762 . This is a "NPI-INDIVIDUAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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