MEDICARE: MD URGENT CARE WALK-IN CLINIC INC.

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	261QU0200X	Urgent Care Clinic/Center	HCC10695	FL

General Provider Information

NPI Number	:	1417399551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MD URGENT CARE WALK-IN CLINIC INC.

Provider Business Mailing Address
First Line	:	7104 S MILITARY TRL
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-7812
Country	:	US
Telephone Number	:	561-969-3710
Fax Number	:	561-969-3811

Provider Business Practice Location Address
First Line	:	7104 S MILITARY TRL
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-7812
Country	:	US
Telephone Number	:	561-969-3710
Fax Number	:	561-969-3811

Authorized Official
Title or Position	:	DIRECTOR
Name	:	NERLANDE ESTINABLE
Credential	:
Telephone Number	:	561-969-3710

Provider Enumeration Date	:	07/17/2013
Last Update Date	:	07/17/2013

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