Healthcare Provider Details

I. General information

NPI: 1528510443
Provider Name (Legal Business Name): FAMILY MEDICAL WALK-IN CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4049 S CAMPBELL AVE
SPRINGFIELD MO
65807-5303
US

IV. Provider business mailing address

3876 STATE HIGHWAY ZZ
BILLINGS MO
65610-9068
US

V. Phone/Fax

Practice location:
  • Phone: 417-890-5550
  • Fax:
Mailing address:
  • Phone: 417-773-3429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number2016037515
License Number StateMO

VIII. Authorized Official

Name: DR. DANIEL BURKE
Title or Position: CEO
Credential: D.O.
Phone: 417-890-5550