Basic Information
| Provider Information | |||||||||
| NPI: | 1487196440 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAYCARE URGENT CARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2995 DREW STREET | ||||||||
| Address2: | EAST BLDG 2ND FLOOR | ||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7272819390 | ||||||||
| FaxNumber: | 8136352613 | ||||||||
| Practice Location | |||||||||
| Address1: | 36245 HWY 27 | ||||||||
| Address2: | |||||||||
| City: | HAINES CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338443744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8638669933 | ||||||||
| FaxNumber: | 8632297556 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2016 | ||||||||
| LastUpdateDate: | 01/07/2019 | ||||||||
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| AuthorizedOfficialLastName: | GORKEN | ||||||||
| AuthorizedOfficialFirstName: | LYNDA | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | VP, PFS | ||||||||
| AuthorizedOfficialTelephone: | 7272819390 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BAYCARE URGENT CARE, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | ME58834 | FL | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 274807000 | 05 | FL | MEDICAID |