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Organization
WAL-MART STORES EAST, LP
Active
Organization
WAL-MART STORES EAST, LP
Active
Parent organization
WAL-MART STORES, INC.
Other names
Walmart Care Clinic 10-0511
Organization subpart
Yes
Provider details
NPI number
Legal business name
WAL-MART STORES, INC.
Authorized official
LAURA LEVINE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 204-8550
Entity
Organization
Contact information
Practice address
1283 BROAD ST, SUMTER, SC 29150-1973
(803) 905-5528
(803) 905-5530
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D953
MEDICARE PTAN
SC
05
—
GP6498
—
SC
Enumeration date
06/24/2014
Last updated
02/19/2015
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