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22945 State Road 54 Lutz FL 33549-6932 | |
| (813) 909-9099 | |
| (813) 909-1822 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Urgent Care |
| Location | 22945 State Road 54, Lutz, Florida |
| Authorized Official Name and Position | Joy Kimball (CONTRACT MANAGER) |
| Authorized Official Contact | 7633496740 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
423 Fortress Blvd Morgantown WV 26508-1351 Ph: (304) 225-2500 | 22945 State Road 54 Lutz FL 33549-6932 Ph: (813) 909-9099 |
| NPI Number | 1225087430 |
|---|---|
| Provider Enumeration Date | 05/08/2006 |
| Last Update Date | 05/07/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225087430 | NPI | - | NPPES |
| 018112900 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
| 261QU0200X | Clinic/center - Urgent Care | (* (Not Available)) | Primary |
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