Provider Demographics
NPI:1700198421
Name:SUMMIT WALK-IN CLINIC, LLC
Entity Type:Organization
Organization Name:SUMMIT WALK-IN CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-373-7600
Mailing Address - Street 1:669 S MT. JULIET RD
Mailing Address - Street 2:
Mailing Address - City:MT. JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-0001
Mailing Address - Country:US
Mailing Address - Phone:615-758-2929
Mailing Address - Fax:615-758-2919
Practice Address - Street 1:669 S MT. JULIET RD
Practice Address - Street 2:
Practice Address - City:MT. JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-0001
Practice Address - Country:US
Practice Address - Phone:615-758-2929
Practice Address - Fax:615-758-2919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-10
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty