NPIMap

Organization Active NPI

Physicians Immediate Care Southwest, LLC

  • Urgent Care Clinic/Center
  • Port St Lucie, FL
National Provider Identifier
1063808301
Registry record updated Apr 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
License
HCC5630 Issued in FL
Legal business name
PHYSICIANS IMMEDIATE CARE SOUTHWEST, LLC
Practice address
4007 SW Port St Lucie Blvd
Port St Lucie, FL 34953-5679
Phone
(772) 343-1774
Fax
(772) 343-1744
NPI assigned
Apr 14, 2015
Last updated
Apr 14, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
PHYSICIANS IMMEDIATE CARE, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 14, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kenneth Palestrant, M.D.
Title
Ceo
Phone
(772) 343-1776

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X HCC5630 FL Primary

Addresses

Primary practice location

4007 SW Port St Lucie Blvd
Port St Lucie, FL 34953-5679

Mailing address

4007 SW Port St Lucie Blvd
Port St Lucie, FL 34953-5679
Phone (772) 343-1774

National Provider Directory

National Provider Directory
Tax ID family
Physicians Immediate Ca3 organizations share this tax ID, including this one
Part of
Physicians Immediate Ca

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1428969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428969600000",
    "number": "1063808301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4007 SW PORT ST LUCIE BLVD",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349535679",
            "telephone_number": "772-343-1774",
            "fax_number": "772-343-1744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4007 SW PORT ST LUCIE BLVD",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349535679",
            "telephone_number": "772-343-1774",
            "fax_number": "772-343-1744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIANS IMMEDIATE CARE SOUTHWEST, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHYSICIANS IMMEDIATE CARE, INC",
        "enumeration_date": "2015-04-14",
        "last_updated": "2015-04-14",
        "status": "A",
        "authorized_official_last_name": "PALESTRANT",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "772-343-1776",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "FL",
            "license": "HCC5630",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port St Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.