Organization
CRESTVIEW URGENT CARE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES JOSEPH CLANCY PA-C (PHYSICIAN ASSISTANT)
(850) 398-8668
Entity
Organization
Contact information
Practice address
1502 S FERDON BLVD, CRESTVIEW, FL 32536-8444
(850) 398-1079
Mailing address
1502 S FERDON BLVD, CRESTVIEW, FL 32536-8444
(850) 398-8668
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
ME93880
FL
Other
Enumeration date
06/23/2009
Last updated
08/27/2010
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