Organization
WALK IN MEDICAL CLINIC AND FITNESS CENTER, LLC
Active
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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