Provider Demographics
NPI:1386749000
Name:GULF VIEW WALK IN CLINIC,INC
Entity type:Organization
Organization Name:GULF VIEW WALK IN CLINIC,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GUNWANT
Authorized Official - Middle Name:S
Authorized Official - Last Name:DHALIWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-844-5555
Mailing Address - Street 1:6329 STATE ROAD 54
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-6037
Mailing Address - Country:US
Mailing Address - Phone:727-844-5555
Mailing Address - Fax:727-844-5553
Practice Address - Street 1:6329 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-6037
Practice Address - Country:US
Practice Address - Phone:727-844-5555
Practice Address - Fax:727-844-5553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0062180207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257866200Medicaid
FL257866204Medicaid
FL257866204Medicaid
FL21465Medicare PIN