NPIMap

Organization Active NPI

Physicians Immediate Care

  • Non-Pharmacy Dispensing Site
  • Port St Lucie, FL
National Provider Identifier
1952572430
Registry record updated Mar 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
FP0126222 Issued in FL
Legal business name
PHYSICIANS IMMEDIATE CARE
Practice address
4007 SW Port St Lucie Blvd
Suite #12
Port St Lucie, FL 34953-5679
Phone
(772) 343-1774
Fax
(772) 343-1744
NPI assigned
Mar 12, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2008

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

Authorized official

Name
Kenneth J Palestrant
Title
Physician
Phone
(772) 343-1774

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X FP0126222 FL Primary

Addresses

Primary practice location

4007 SW Port St Lucie Blvd
Suite #12
Port St Lucie, FL 34953-5679

Mailing address

3607 Old Conejo Rd
Thousand Oaks, CA 91320-2123
Phone (805) 375-0800

National Provider Directory

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

Other organizations with this tax ID 2

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

Locations

4007 SW Port St Lucie Blvd
Ste 12
Port St Lucie, FL 34953
Phone (772) 343-1774

NPI Registry JSON

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

{
    "created_epoch": "1205280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205280000000",
    "number": "1952572430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3607 OLD CONEJO RD",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913202123",
            "telephone_number": "805-375-0800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4007 SW PORT ST LUCIE BLVD",
            "address_2": "SUITE #12",
            "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",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-12",
        "last_updated": "2008-03-12",
        "status": "A",
        "authorized_official_last_name": "PALESTRANT",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "772-343-1774"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "FL",
            "license": "FP0126222",
            "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 Mar 12, 2008; 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.