Provider Demographics
NPI:1629027008
Name:JOGI WALK-IN CLINIC INC
Entity type:Organization
Organization Name:JOGI WALK-IN CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUGUNA
Authorized Official - Middle Name:KUMARI
Authorized Official - Last Name:MANGILIPUDI
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:863-682-8200
Mailing Address - Street 1:1500 LAKELAND HILLS BLVD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3257
Mailing Address - Country:US
Mailing Address - Phone:863-682-8200
Mailing Address - Fax:863-687-4161
Practice Address - Street 1:1500 LAKELAND HILLS BLVD
Practice Address - Street 2:SUITE #3
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3257
Practice Address - Country:US
Practice Address - Phone:863-682-8200
Practice Address - Fax:863-687-4161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7398Medicare PIN