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General NPI Number Information
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NPI Number | 1912317413
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Entity Type | Organization
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Legal Business Name | TRI-CITY WALK-IN CLINIC
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Dates
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Enumeration Date | 05/06/2014
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Last Update Date | 05/06/2014
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Provider Practice Location Address
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Address Line | 33281 CORTEZ BLVD
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City | DADE CITY
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State | FL
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Zip | 33523-9008
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Country | US
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Telephone | 850-333-0889
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Fax |
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Provider Business Mailing Address
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Address Line | 9W ORANGE AVE.
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City | DEFUNIAK SPRING
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State | FL
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Zip | 32435
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Country | US
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Telephone | 850-865-3997
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN'S ASSIST.
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Name | MR. ANWAR CHOWDHURY
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Credential | P.A.
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Telephone | 850-865-3997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number | PA9100777
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License Number State | FL
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