MEDICARE: CONVENIENT WALK IN MEDICAL 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	207Q00000X	Family Medicine Physician	ME31419	FL

General Provider Information

NPI Number	:	1871798587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONVENIENT WALK IN MEDICAL CLINIC INC

Provider Business Mailing Address
First Line	:	1611 E SHELL POINT RD
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33570-5087
Country	:	US
Telephone Number	:	813-659-2502
Fax Number	:	813-659-2584

Provider Business Practice Location Address
First Line	:	1611 E SHELL POINT RD
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33570-5087
Country	:	US
Telephone Number	:	813-659-2502
Fax Number	:	813-659-2584

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	BRIAN CLUKIE
Credential	:
Telephone Number	:	813-659-2502

Provider Enumeration Date	:	06/21/2007
Last Update Date	:	09/26/2007

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Directions to “CONVENIENT WALK IN MEDICAL CLINIC INC ” Practice Location

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