Provider Demographics
NPI:1952438020
Name:WALK IN CLINIC OF SPARTA LLC.
Entity type:Organization
Organization Name:WALK IN CLINIC OF SPARTA LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DURBIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICIAN ASSISTANT
Authorized Official - Phone:931-836-2228
Mailing Address - Street 1:396 N SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-1327
Mailing Address - Country:US
Mailing Address - Phone:931-836-2228
Mailing Address - Fax:
Practice Address - Street 1:396 N SPRING ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-1327
Practice Address - Country:US
Practice Address - Phone:931-836-2228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000000834363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3725921OtherMEDICARE GROUP PTAN NUMBER
TNS29477Medicare UPIN
TN6140670001Medicare NSC