MEDICARE: UNIVERSITY WALK-IN MEDICAL CENTER, 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
1	261QU0200X	Urgent Care Clinic/Center
2	207P00000X	Emergency Medicine Physician	OS8339	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	B901V	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1629189410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY WALK-IN MEDICAL CENTER, INC

Provider Business Mailing Address
First Line	:	11550 UNIVERSITY BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32817-2100
Country	:	US
Telephone Number	:	407-282-2044
Fax Number	:	407-658-1596

Provider Business Practice Location Address
First Line	:	11550 UNIVERSITY BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32817-2100
Country	:	US
Telephone Number	:	407-282-2044
Fax Number	:	407-658-1596

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	VICTOR YOUNG
Credential	:	D.O.
Telephone Number	:	407-282-2044

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	12/10/2009

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