Provider Demographics
NPI:1871750224
Name:NAVARRE URGENT CARE, LLC
Entity type:Organization
Organization Name:NAVARRE URGENT CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CLANCY
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:850-515-1174
Mailing Address - Street 1:2053 FOUNTAIN PROFESSIONAL CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-5105
Mailing Address - Country:US
Mailing Address - Phone:850-515-1174
Mailing Address - Fax:
Practice Address - Street 1:2053 FOUNTAIN PROFESSIONAL CT
Practice Address - Street 2:SUITE B
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-5105
Practice Address - Country:US
Practice Address - Phone:850-515-1174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care