Provider Demographics
NPI:1700292547
Name:MEDCARE XPRESS WALK-IN CLINIC OF KISSIMMEE,LLC
Entity Type:Organization
Organization Name:MEDCARE XPRESS WALK-IN CLINIC OF KISSIMMEE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:HILL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:407-780-6401
Mailing Address - Street 1:1122 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4283
Mailing Address - Country:US
Mailing Address - Phone:407-378-5300
Mailing Address - Fax:407-530-5692
Practice Address - Street 1:1122 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4283
Practice Address - Country:US
Practice Address - Phone:407-378-5300
Practice Address - Fax:407-745-5589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-01
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care