Provider Demographics
NPI:1568885911
Name:PRIMERA CHOICE WALK IN CLINIC OF ALTAMONTE
Entity Type:Organization
Organization Name:PRIMERA CHOICE WALK IN CLINIC OF ALTAMONTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DC
Authorized Official - Prefix:MR
Authorized Official - First Name:JUNAID
Authorized Official - Middle Name:Q
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:CEO/OWNER/DC
Authorized Official - Phone:321-280-5052
Mailing Address - Street 1:280 S STATE ROAD 434 STE 1049A
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-3859
Mailing Address - Country:US
Mailing Address - Phone:321-280-5052
Mailing Address - Fax:
Practice Address - Street 1:280 S STATE ROAD 434 STE 1049A
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3859
Practice Address - Country:US
Practice Address - Phone:321-280-5052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10638261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center