Provider Demographics
NPI:1760432231
Name:DOCTORS URGENT CARE WALK-IN CLINIC
Entity Type:Organization
Organization Name:DOCTORS URGENT CARE WALK-IN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-520-7900
Mailing Address - Street 1:4900 33RD AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-2102
Mailing Address - Country:US
Mailing Address - Phone:727-520-7900
Mailing Address - Fax:727-526-9179
Practice Address - Street 1:4900 33RD AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-2102
Practice Address - Country:US
Practice Address - Phone:727-520-7900
Practice Address - Fax:727-526-9179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7765174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID