Provider Demographics
NPI:1437333002
Name:VISALIA WALK IN MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:VISALIA WALK IN MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:URSULINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PIRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-627-5555
Mailing Address - Street 1:2431 W CALDWELL AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277
Mailing Address - Country:US
Mailing Address - Phone:559-627-5555
Mailing Address - Fax:559-734-1984
Practice Address - Street 1:2431 W CALDWELL AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277
Practice Address - Country:US
Practice Address - Phone:559-627-5555
Practice Address - Fax:559-734-1984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC27178207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ15506ZOtherMEDICARE PROVIDER
ZZZ15506ZOtherMEDICARE PROVIDER