Provider Demographics
NPI:1376848978
Name:FAMILY MEDICAL WALK-IN CLINIC PA
Entity Type:Organization
Organization Name:FAMILY MEDICAL WALK-IN CLINIC PA
Other - Org Name:ROGERS FAMILY MEDICAL WALK-IN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:417-890-5550
Mailing Address - Street 1:4049 S CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5303
Mailing Address - Country:US
Mailing Address - Phone:417-890-5550
Mailing Address - Fax:417-889-6898
Practice Address - Street 1:1310 W WALNUT ST
Practice Address - Street 2:SUITE F
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3316
Practice Address - Country:US
Practice Address - Phone:855-707-5550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY MEDICAL WALK-IN CLINIC PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-13
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR186131002Medicaid
AR5G757Medicare PIN