Provider Demographics
NPI:1972318491
Name:PEDIATRIC URGENT CARE GROUP OF ORMOND BEACH
Entity type:Organization
Organization Name:PEDIATRIC URGENT CARE GROUP OF ORMOND BEACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:E
Authorized Official - Last Name:QUINTEROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-425-4414
Mailing Address - Street 1:1688 W GRANADA BLVD STE 1A
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-1818
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1688 W GRANADA BLVD STE 1A
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-1818
Practice Address - Country:US
Practice Address - Phone:386-316-6276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRIC URGENT CARE GROUP OF ORMOND BEACH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty