MEDICARE: SARASOTA FAMILY MEDICAL WALK-IN CLINIC AND DIAGNOSTIC CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME 0079271	FL

General Provider Information

NPI Number	:	1376564476
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SARASOTA FAMILY MEDICAL WALK-IN CLINIC AND DIAGNOSTIC CENTER

Provider Business Mailing Address
First Line	:	6813 S TAMIAMI TRL
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34231-5603
Country	:	US
Telephone Number	:	941-923-5861
Fax Number	:	941-926-4547

Provider Business Practice Location Address
First Line	:	6813 S TAMIAMI TRL
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34231-5603
Country	:	US
Telephone Number	:	941-923-5861
Fax Number	:	941-926-4547

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. SHARON LYNN FREDERICKS
Credential	:
Telephone Number	:	941-923-5861

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	08/22/2020

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