Provider Demographics
NPI:1174780589
Name:YOUR CARE CLINICS LLC
Entity type:Organization
Organization Name:YOUR CARE CLINICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-588-7665
Mailing Address - Street 1:10225 ULMERTON RD STE 9A
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-3526
Mailing Address - Country:US
Mailing Address - Phone:727-588-7665
Mailing Address - Fax:727-230-9194
Practice Address - Street 1:10225 ULMERTON RD
Practice Address - Street 2:SUITE 9A
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3538
Practice Address - Country:US
Practice Address - Phone:727-588-7600
Practice Address - Fax:727-230-9194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2523919OtherAETNA-HMO
FL6806670OtherCIGNA
FL277731201Medicaid
FLJ804OtherAVMED
FL54473357OtherCOLORADO MEDICAID
FL39469OtherBLUE CROSS BLUE SHIELD OF FLORIDA
FL7566598OtherAETNA
FL=========001OtherTRICARE
FL=========001OtherTRICARE