1548395379 NPI number — DOCTORS R US WALK-IN CLINIC

Table of content: (NPI 1548395379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548395379 NPI number — DOCTORS R US WALK-IN CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOCTORS R US WALK-IN CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548395379
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6821 W HILLSBOROUGH AVE STE 19
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33634-5003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-890-0705
Provider Business Mailing Address Fax Number:
813-890-0710

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6821 W HILLSBOROUGH AVE STE 19
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33634-5003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-890-0705
Provider Business Practice Location Address Fax Number:
813-890-0710
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ADORNO
Authorized Official First Name:
GIL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
813-890-0705

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8482 . This is a "SOUTHCARE UCC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: B902P . This is a "BC BS URGENT CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 5807 . This is a "CARE PLUS UCC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 9179149 . This is a "AETNA UCC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 120805 . This is a "HUMANA UCC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 282269 . This is a "AVMED UCC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 6600432 . This is a "UNITED UCC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 5807 . This is a "CITRUS UCC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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