MEDICARE: TRI-CITY WALK-IN CLINIC

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	174H00000X	Health Educator	PA9100777	FL

General Provider Information

NPI Number	:	1912317413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-CITY WALK-IN CLINIC

Provider Business Mailing Address
First Line	:	9W ORANGE AVE.
Second Line	:
City	:	DEFUNIAK SPRING
State	:	FL
Zip	:	32435
Country	:	US
Telephone Number	:	850-865-3997
Fax Number	:

Provider Business Practice Location Address
First Line	:	33281 CORTEZ BLVD
Second Line	:
City	:	DADE CITY
State	:	FL
Zip	:	33523-9008
Country	:	US
Telephone Number	:	850-333-0889
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN'S ASSIST.
Name	:	MR. ANWAR CHOWDHURY
Credential	:	P.A.
Telephone Number	:	850-865-3997

Provider Enumeration Date	:	05/06/2014
Last Update Date	:	05/06/2014

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Directions to “TRI-CITY WALK-IN CLINIC ” Practice Location

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