Provider Demographics
NPI:1033262019
Name:PREMIER WALK IN CLINIC & PRIMARY CARE LLC
Entity Type:Organization
Organization Name:PREMIER WALK IN CLINIC & PRIMARY CARE LLC
Other - Org Name:PREMIER WALK IN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NARINDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:BRAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-644-3400
Mailing Address - Street 1:5676 S FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2526
Mailing Address - Country:US
Mailing Address - Phone:863-644-3400
Mailing Address - Fax:863-619-2400
Practice Address - Street 1:5676 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2526
Practice Address - Country:US
Practice Address - Phone:863-644-3400
Practice Address - Fax:863-619-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-21
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65736261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9032OtherMEDICARE GROUP PTAN
FLK9032OtherMEDICARE GROUP PTAN