Healthcare Provider Details

I. General information

NPI: 1053584144
Provider Name (Legal Business Name): FLYNN CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 04/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 S FLORIDA AVE
LAKELAND FL
33813-1105
US

IV. Provider business mailing address

3810 S FLORIDA AVE
LAKELAND FL
33813-1105
US

V. Phone/Fax

Practice location:
  • Phone: 863-646-5111
  • Fax:
Mailing address:
  • Phone: 863-646-5111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name: WENDY LYNN SCHWEITZ FLYNN
Title or Position: PRES
Credential: DC
Phone: 863-398-4114