Provider Demographics
NPI:1912317413
Name:TRI-CITY WALK-IN CLINIC
Entity Type:Organization
Organization Name:TRI-CITY WALK-IN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN'S ASSIST.
Authorized Official - Prefix:MR
Authorized Official - First Name:ANWAR
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOWDHURY
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:850-865-3997
Mailing Address - Street 1:9W ORANGE AVE.
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRING
Mailing Address - State:FL
Mailing Address - Zip Code:32435
Mailing Address - Country:US
Mailing Address - Phone:850-865-3997
Mailing Address - Fax:
Practice Address - Street 1:33281 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33523-9008
Practice Address - Country:US
Practice Address - Phone:850-333-0889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100777174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty