Provider Demographics
NPI:1275358855
Name:ST TIMOTHY URGENT CARE
Entity type:Organization
Organization Name:ST TIMOTHY URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EID
Authorized Official - Middle Name:
Authorized Official - Last Name:GUIRGUIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-835-7111
Mailing Address - Street 1:16244 REDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-4668
Mailing Address - Country:US
Mailing Address - Phone:352-835-7111
Mailing Address - Fax:
Practice Address - Street 1:16244 REDSTONE WAY
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-4668
Practice Address - Country:US
Practice Address - Phone:352-835-7111
Practice Address - Fax:727-223-4159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency MedicineGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care