Healthcare Provider Details

I. General information

NPI: 1750755971
Provider Name (Legal Business Name): TRI-CITY WALK-IN CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2015
Last Update Date: 05/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33281 CORTEZ BLVD
DADE CITY FL
33523-9008
US

IV. Provider business mailing address

17947 GOURD NECK LOOP
WINTER GARDEN FL
34787-3090
US

V. Phone/Fax

Practice location:
  • Phone: 850-865-3997
  • Fax:
Mailing address:
  • Phone: 850-865-3997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberPA9100777
License Number StateFL

VIII. Authorized Official

Name: MR. ANWAR CHOWDHURY
Title or Position: OWNER
Credential:
Phone: 850-865-3997