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NPI Code Detail

MEDICARE: SAN LUIS WALK-IN CLINIC, INC.

MEDICARE: SAN LUIS WALK-IN CLINIC, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM1300XMulti-Specialty Clinic/Center
2261QR1300XRural Health Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2OTC3530OTHERAZADHS LICENSE

General Provider Information

NPI Number : 1104228337
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAN LUIS WALK-IN CLINIC, INC.
Provider Business Mailing Address
First Line : PO BOX 617
Second Line :
City : SOMERTON
State : AZ
Zip : 85350-0617
Country : US
Telephone Number : 928-315-7910
Fax Number : 928-722-6113
Provider Business Practice Location Address
First Line : 1896 E BABBIT LN
Second Line :
City : SAN LUIS
State : AZ
Zip : 85336-7820
Country : US
Telephone Number : 928-722-6112
Fax Number : 928-722-6113
Authorized Official
Title or Position : PRESIDENT & CEO
Name : AMANDA AGUIRRE
Credential : R.D.
Telephone Number : 928-315-7910
Provider Enumeration Date : 09/18/2014
Last Update Date : 09/07/2023

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Directions to “SAN LUIS WALK-IN CLINIC, INC. ” Practice Location

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