MEDICARE: FAMILY MEDICAL 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	R5B57	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417928094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY MEDICAL WALK-IN CLINIC INC

Provider Business Mailing Address
First Line	:	4049 S CAMPBELL AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-5303
Country	:	US
Telephone Number	:	417-890-5550
Fax Number	:	417-889-6898

Provider Business Practice Location Address
First Line	:	103 N OLD WILDERNESS RD
Second Line	:
City	:	NIXA
State	:	MO
Zip	:	65714-9057
Country	:	US
Telephone Number	:	417-890-5550
Fax Number	:	417-351-6121

Authorized Official
Title or Position	:	OWNER/MEDICAL DIRECTOR
Name	:	DR. DANIEL J BURKE
Credential	:	D.O.
Telephone Number	:	417-890-5550

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	03/30/2018

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