Provider Demographics
NPI:1033566286
Name:WALK-IN CLINIC, LLC
Entity Type:Organization
Organization Name:WALK-IN CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS DEVELOPMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYBURN
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:MITCHUM
Authorized Official - Suffix:III
Authorized Official - Credentials:BS
Authorized Official - Phone:936-553-3417
Mailing Address - Street 1:PO BOX 633821
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75963-3821
Mailing Address - Country:US
Mailing Address - Phone:936-564-7373
Mailing Address - Fax:936-564-9338
Practice Address - Street 1:1516 S 31ST ST
Practice Address - Street 2:SUITE B
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-6752
Practice Address - Country:US
Practice Address - Phone:254-778-6626
Practice Address - Fax:254-221-8079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty