Provider Demographics
NPI:1790948941
Name:SUNSHINE WALK IN CLINIC
Entity Type:Organization
Organization Name:SUNSHINE WALK IN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAGEH
Authorized Official - Middle Name:S
Authorized Official - Last Name:BARSOUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-729-1400
Mailing Address - Street 1:5205 BABCOCK ST NE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-4638
Mailing Address - Country:US
Mailing Address - Phone:321-729-1400
Mailing Address - Fax:321-728-5700
Practice Address - Street 1:5205 BABCOCK ST NE
Practice Address - Street 2:SUITE 3
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-4638
Practice Address - Country:US
Practice Address - Phone:321-729-1400
Practice Address - Fax:321-728-5700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264156900Medicaid
FL264156901Medicaid
U1867YMedicare PIN
FL264156900Medicaid