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General NPI Number Information
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NPI Number | 1033262019
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Entity Type | Organization
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Legal Business Name | PREMIER WALK IN CLINIC & PRIMARY CARE LLC
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Dates
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Enumeration Date | 01/21/2007
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Last Update Date | 10/16/2014
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Provider Practice Location Address
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Address Line | 5676 S FLORIDA AVE
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City | LAKELAND
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State | FL
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Zip | 33813-2526
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Country | US
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Telephone | 863-644-3400
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Fax | 863-619-2400
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Provider Business Mailing Address
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Address Line | 5676 S FLORIDA AVE
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City | LAKELAND
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State | FL
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Zip | 33813-2526
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Country | US
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Telephone | 863-644-3400
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Fax | 863-619-2400
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Authorized Official
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Title or Position | OWNER
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Name | DR. NARINDER S BRAR
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Credential | MD
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Telephone | 863-644-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME65736
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License Number State | FL
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