Healthcare Provider Details

I. General information

NPI: 1982147120
Provider Name (Legal Business Name): MEDVITAL WALK IN LAB AND CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 W OAK ST
KISSIMMEE FL
34741-4443
US

IV. Provider business mailing address

320 W OAK ST
KISSIMMEE FL
34741-4443
US

V. Phone/Fax

Practice location:
  • Phone: 888-944-5227
  • Fax: 407-874-1290
Mailing address:
  • Phone: 888-944-5227
  • Fax: 407-874-1290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIA ABREU
Title or Position: OFFICE MANAGER
Credential:
Phone: 888-944-5227