Healthcare Provider Details

I. General information

NPI: 1164021945
Provider Name (Legal Business Name): WALK-IN FAMILY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2020
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 SAXON BLVD
ORANGE CITY FL
32763-8313
US

IV. Provider business mailing address

926 SAXON BLVD
ORANGE CITY FL
32763-8313
US

V. Phone/Fax

Practice location:
  • Phone: 386-774-1881
  • Fax: 386-774-1264
Mailing address:
  • Phone: 386-774-1881
  • Fax: 386-774-1264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN WEISS
Title or Position: OWNER
Credential:
Phone: 386-774-1881