| Organization Name: | CRESTVIEW URGENT CARE, INC. |
| NPI Number: | 1144458647 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHARLES JOSEPH CLANCY (PHYSICIAN ASSISTANT) |
| Mailing Address: | 1502 S Ferdon Blvd Crestview |
| State: | FL US |
| Postal Code: | 325368444 |
| Phone Number: | 8503981079 |
| Fax Number: | |
| NPI Enumeration Date: | 06/23/2009 |
| NPI Last Update Date: | 08/27/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | ME93880 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |