Provider Demographics
NPI:1376564476
Name:SARASOTA FAMILY MEDICAL WALK-IN CLINIC AND DIAGNOSTIC CENTER
Entity Type:Organization
Organization Name:SARASOTA FAMILY MEDICAL WALK-IN CLINIC AND DIAGNOSTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FREDERICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-923-5861
Mailing Address - Street 1:6813 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-5603
Mailing Address - Country:US
Mailing Address - Phone:941-923-5861
Mailing Address - Fax:941-926-4547
Practice Address - Street 1:6813 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-5603
Practice Address - Country:US
Practice Address - Phone:941-923-5861
Practice Address - Fax:941-926-4547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0079271207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE54241Medicare UPIN
FL3809978Medicare ID - Type UnspecifiedJOHN W. MEYER JR., M.D.
FL49404CMedicare ID - Type UnspecifiedCLAUDE J. MASON, M.D.
FLE43811Medicare UPIN