Provider Demographics
| NPI: | 1003647587 |
|---|---|
| Name: | ISLAND CITY URGENT CARE PA |
| Entity type: | Organization |
| Organization Name: | ISLAND CITY URGENT CARE PA |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OWNER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | KYLE |
| Authorized Official - Middle Name: | JAMES |
| Authorized Official - Last Name: | OLEARY |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | APRN |
| Authorized Official - Phone: | 954-391-7160 |
| Mailing Address - Street 1: | 1442 NE 26TH ST |
| Mailing Address - Street 2: | |
| Mailing Address - City: | WILTON MANORS |
| Mailing Address - State: | FL |
| Mailing Address - Zip Code: | 33305-1322 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 954-391-7160 |
| Mailing Address - Fax: | 954-393-0811 |
| Practice Address - Street 1: | 1442 NE 26TH ST |
| Practice Address - Street 2: | |
| Practice Address - City: | WILTON MANORS |
| Practice Address - State: | FL |
| Practice Address - Zip Code: | 33305-1322 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 954-391-7160 |
| Practice Address - Fax: | 954-393-0811 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | ISLAND CITY URGENT CARE PA |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2024-08-08 |
| Last Update Date: | 2025-12-01 |
| Deactivation Date: | 2025-08-19 |
| Deactivation Code: | |
| Reactivation Date: | 2025-10-13 |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | |
| No | 363LP2300X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | Group - Multi-Specialty |
| No | 261QX0100X | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine | |
| No | 261QR0200X | Ambulatory Health Care Facilities | Clinic/Center | Radiology | |
| No | 261QU0200X | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | Group - Multi-Specialty |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | ||
| No | 332900000X | Suppliers | Non-Pharmacy Dispensing Site | Group - Multi-Specialty | |
| No | 261QS1000X | Ambulatory Health Care Facilities | Clinic/Center | Student Health | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 3336C0002X | Suppliers | Pharmacy | Clinic Pharmacy | |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
| No | 363LX0106X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Occupational Health | Group - Multi-Specialty |
| No | 207ZP0105X | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine | Group - Multi-Specialty |
| No | 305S00000X | Managed Care Organizations | Point of Service | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| FL | 11021418 | Other | APRN |
| FL | 1245103449 | Other | NPI |
| FL | JR5657900 | Other | RADIOLOGYXRAY |
| FL | TU149 | Medicaid | |
| FL | 1417679762 | Other | NPI |
| FL | 82907 | Other | PHARMACY |
| FL | TU148 | Medicaid |
