Basic Information
| Provider Information | |||||||||
| NPI: | 1124083282 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | URGENT CARE CENTER OF GAINESVILLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3925 NW 43RD ST | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326064565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523711777 | ||||||||
| FaxNumber: | 3523710298 | ||||||||
| Practice Location | |||||||||
| Address1: | 3925 NW 43RD ST | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326064565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523711777 | ||||||||
| FaxNumber: | 3523710298 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | PAMINTUAN | ||||||||
| AuthorizedOfficialFirstName: | ROGELIO | ||||||||
| AuthorizedOfficialMiddleName: | V | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3523711777 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
ID Information
| ID | Type | State | Issuer | Description | B903G | 01 | FL | BLUE CROSS/BLUE SHIELD | OTHER |