Provider Demographics
NPI:1699449462
Name:411 URGENT CARE LLC
Entity type:Organization
Organization Name:411 URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL / OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ADAMASTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:352-274-4307
Mailing Address - Street 1:17820 SE 109TH AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-8968
Mailing Address - Country:US
Mailing Address - Phone:352-547-9378
Mailing Address - Fax:352-559-3939
Practice Address - Street 1:17820 SE 109TH AVE STE 108
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-8968
Practice Address - Country:US
Practice Address - Phone:352-547-9378
Practice Address - Fax:352-559-3939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-05
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care