Provider Demographics
NPI:1245103449
Name:ISLAND CITY URGENT CARE PA
Entity type:Organization
Organization Name:ISLAND CITY URGENT CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:OLEARY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:954-391-7160
Mailing Address - Street 1:1442 NE 26TH ST
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1322
Mailing Address - Country:US
Mailing Address - Phone:954-391-7160
Mailing Address - Fax:954-393-0811
Practice Address - Street 1:1442 NE 26TH ST
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1322
Practice Address - Country:US
Practice Address - Phone:954-391-7160
Practice Address - Fax:954-393-0811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-25
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational MedicineGroup - Multi-Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No332900000XSuppliersNon-Pharmacy Dispensing Site
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No305S00000XManaged Care OrganizationsPoint of ServiceGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJR5657900OtherXRAY
FL82907OtherPHARMACY
FL1003647587OtherNPI-GROUP
FL11021418OtherAPRN
FL15988989OtherCAHQ
FLALAOtherFLORIDABLUE
FL124809600Medicaid
FL10D2317428OtherCLIA
FL1417679762OtherNPI-INDIVIDUAL