Basic Information
| Provider Information | |||||||||
| NPI: | 1508871948 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CRITICARE CLINICS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11825 | ||||||||
| Address2: | |||||||||
| City: | DAYTONA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321201825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056692833 | ||||||||
| FaxNumber: | 3056692840 | ||||||||
| Practice Location | |||||||||
| Address1: | 14701 NW 77TH AVE | ||||||||
| Address2: | |||||||||
| City: | MIAMI LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330142559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056654614 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 11/12/2021 | ||||||||
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| AuthorizedOfficialLastName: | KRANICHFELD | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3056654614 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 11/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | N | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 277160801 | 05 | FL | MEDICAID | 277160800 | 05 | FL | MEDICAID | 277160802 | 05 | FL | MEDICAID |