Provider Demographics
NPI:1851444350
Name:ST LUCIE MEDICAL CENTER WALK-IN CLINIC LLC
Entity Type:Organization
Organization Name:ST LUCIE MEDICAL CENTER WALK-IN CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-873-0303
Mailing Address - Street 1:140 SW CHAMBER CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3496
Mailing Address - Country:US
Mailing Address - Phone:772-873-0303
Mailing Address - Fax:772-873-0353
Practice Address - Street 1:140 SW CHAMBER CT
Practice Address - Street 2:SUITE 100
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3496
Practice Address - Country:US
Practice Address - Phone:772-873-0303
Practice Address - Fax:772-873-0353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAC595Medicare PIN
FLD0575Medicare PIN