1St Choice Urgent Care Center LLC
Organization Active NPI Primary Care Clinic/Center · Lake Butler, FL
NPI 1760152508 · NPPES record last updated Jul 29, 2022
Key facts
- NPI
- 1760152508
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- Legal business name
- 1ST CHOICE URGENT CARE CENTER LLC
- Practice address
- 275 W Main St
Lake Butler, FL 32054-1656 - Phone
- (864) 962-2733
- NPI assigned
- Sep 14, 2021
- Organization subpart
- Yes
- Parent organization (as reported)
- 1ST CHOICE URGENT CARE CENTER LLC
Authorized official
- Name
- John Distefano
- Title
- Clinical Consultant
- Phone
- (352) 317-3214
Parent organization (reported in NPPES) 1
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 2
Practitioners 2
-
Bret N Wiechmann, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Rural health clinic certification: CCN 683848
- Legal name
- 1ST CHOICE URGENT CARE CENTER LLC
- Doing business as
- 1ST CHOICE PRIMARY CARE
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jan 30, 2024
- Last certification
- Dec 1, 2023
- Ownership / control type
- 2B
- Organization structure
- LLC · Proprietary
- Incorporated
- Apr 2, 2013 in FL
- Enrollment address
- 275 W Main St
Ste B
Lake Butler, FL 32054-1656
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| John Distefano |
Corporate Officer | Jan 1, 2022 | |
| Operational/Managerial Control | Jan 1, 2022 | ||
| Chris Fortner |
5% Or Greater Direct Ownership Interest |
Jan 28, 2021 | |
| Operational/Managerial Control | Jan 28, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230321001507 | FL | Part a Provider - Rural Health Clinic | 8224276571 | Practice locations: Lake Butler, FL |
National Provider Directory
- Tax ID family
- 1St Choice Urgent Care Center LLC
- Part of
- 1St Choice Urgent Care Center LLC
Locations
817 NW 56th Ter
Ste B
Gainesville, FL 32605
Phone (352) 331-7771
275 W Main St
Ste A
Lake Butler, FL 32054
Phone (386) 496-2273
275 W Main St
Ste B
Lake Butler, FL 32054
Phone (386) 496-2273
275 W Main St
Lake Butler, FL 32054
Phone (386) 496-1236
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | Yes |
Addresses
Primary practice location
275 W Main St
Lake Butler, FL 32054-1656
Mailing address
817 NW 56TH Ter Ste a
Gainesville, FL 32605-6401
Phone (352) 336-0964
Other practice location 1
817 NW 56th Ter Ste B
Gainesville, FL 32605-6401
Phone (352) 336-0964
Other names
- 1st Choice Primary Care
Other providers in Lake Butler, FL
- 1St Choice Urgent Care Center LLC
- A Touch of Heaven Massage Therapy Center, LLC
- Patricia Adelufosi
- Nalini Anandjiwala
- Cheryl Anderson Caska
- Bethany Ann Anderson
All providers in Lake Butler, FL · Primary Care Clinic/Center in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 29, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.