MEDICARE: TRI-CITY 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
1	173000000X	Legal Medicine	PA9100777	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

General Provider Information

NPI Number	:	1750755971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-CITY WALK-IN CLINIC INC

Provider Business Mailing Address
First Line	:	17947 GOURD NECK LOOP
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-3090
Country	:	US
Telephone Number	:	850-865-3997
Fax Number	:

Provider Business Practice Location Address
First Line	:	33281 CORTEZ BLVD
Second Line	:
City	:	DADE CITY
State	:	FL
Zip	:	33523-9008
Country	:	US
Telephone Number	:	850-865-3997
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ANWAR CHOWDHURY
Credential	:
Telephone Number	:	850-865-3997

Provider Enumeration Date	:	11/27/2015
Last Update Date	:	05/01/2016

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