Provider Demographics
NPI:1174306799
Name:NEOCITY WALK IN MEDICAL CARE, LLC
Entity type:Organization
Organization Name:NEOCITY WALK IN MEDICAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INAYAT
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-361-8221
Mailing Address - Street 1:PO BOX 421743
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34742-1743
Mailing Address - Country:US
Mailing Address - Phone:407-530-4446
Mailing Address - Fax:
Practice Address - Street 1:1310 N MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4244
Practice Address - Country:US
Practice Address - Phone:407-530-4446
Practice Address - Fax:407-530-4447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-16
Last Update Date:2023-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty