Provider Demographics
NPI:1821036484
Name:LAKE MARY WALK-IN MEDICAL CENTER
Entity Type:Organization
Organization Name:LAKE MARY WALK-IN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:MARCUS
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-333-0160
Mailing Address - Street 1:870 S SUN DR
Mailing Address - Street 2:SUITE 1030
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2057
Mailing Address - Country:US
Mailing Address - Phone:407-333-0160
Mailing Address - Fax:407-333-0108
Practice Address - Street 1:870 S SUN DR
Practice Address - Street 2:SUITE 1030
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2057
Practice Address - Country:US
Practice Address - Phone:407-333-0160
Practice Address - Fax:407-333-0108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL121341261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDB9538OtherMEDICARE RAILROAD
FLDB9538OtherMEDICARE RAILROAD