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Organization

WALK IN MEDICAL CLINIC AND FITNESS CENTER, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. NICANOR C. LOPEZ M.D. (OWNER)
(267) 475-8447
Entity
Organization

Contact information

Practice address
3105 INNOVATION DR STE A, SAINT CLOUD, FL 34769-6501
(407) 498-0539
(877) 203-2038
Mailing address
3105 INNOVATION DR STE A, SAINT CLOUD, FL 34769-6501
(407) 498-0539
(877) 203-2038

Taxonomy

Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
105419
FL
261QP2300X
Primary Care Clinic/Center
MD037726L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
001759700
FL
01
0368398000
AMERIHEALTH
NJ
05
5114306
NJ
01
550663UKE
MEDICARE ID-TYPE UNSPECIFIED
NJ
01
60018874
HORIZON NJ HEALTH
NJ
Enumeration date
11/10/2010
Last updated
11/11/2010
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