PHYSICIANS IMMEDIATE CARE SOUTHWEST, LLC
Ambulatory Health at Port St Lucie Blvd, Fort Pierce, FL

License number
Florida HCC5630
Category
Ambulatory Health
Type
Urgent Care
Owner
Name: KENNETH PALESTRANT M.D.
Title: CEO
Phone: (772) 343-1776
Address
Address
4007 SW Port St Lucie Blvd, Fort Pierce, FL 34953
National Provider ID: 1063808301
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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PHYSICIANS IMMEDIATE CARE SOUTHWEST, LLC

4007 SW Prt St Lucie Blvd, Port Saint Lucie, FL 34953

Registration:
Jun 11, 2013
State ID:
L13000084168
Business type:
Florida Limited Liability Company
Managing Members:
Kenneth J Palestrant (Managing Member), 4007 SW Prt St Lucie Blvd, Fort Pierce, FL 34982 (Physical),Gabriella Palestrant (Managing Member), 2012 SE Kilmallie Ct, Port Saint Lucie, FL 34952 (Physical),Physicians Immediate Care Group, Llc Managing Member, inactive
Agent:
Reittinger & Associates,4520 Dixie Hwy, Palm Bay, FL 32905 (Physical)
EIN:
46-3014384

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