NPIMap

Organization Active NPI

Dwic of Tampa Bay, Inc

  • Urgent Care Clinic/Center
  • Deland, FL
National Provider Identifier
1124568902
Registry record updated May 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
DWIC OF TAMPA BAY, INC
Practice address
1328 N Woodland Blvd
Deland, FL 32720-2203
Phone
(386) 738-0574
Fax
(386) 738-0573
NPI assigned
Feb 28, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joy Kimball
Title
Contract Manager
Phone
(763) 349-6740

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

1328 N Woodland Blvd
Deland, FL 32720-2203

Mailing address

423 Fortress Blvd
Morgantown, WV 26508-1351
Phone (304) 225-2500

Other names 1

  • MedExpress Urgent Care - DeLand, N Woodland Blvd Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040517001035 FL Part B Supplier - Clinic/Group Practice 3779573167 Receives reassigned benefits from 129 practitioners
22 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lutz, FL; Vero Beach, FL; Tampa, FL; Port Charlotte, FL; North Port, FL; Naples, FL; Lehigh Acres, FL; Largo, FL…

Other NPIs on the same Medicare enrollment 22

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 22

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1488240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715040000000",
    "number": "1124568902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "423 FORTRESS BLVD",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265081351",
            "telephone_number": "304-225-2500",
            "fax_number": "304-985-6350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1328 N WOODLAND BLVD",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327202203",
            "telephone_number": "386-738-0574",
            "fax_number": "386-738-0573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DWIC OF TAMPA BAY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-28",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "status": "A",
        "authorized_official_last_name": "KIMBALL",
        "authorized_official_first_name": "JOY",
        "authorized_official_title_or_position": "CONTRACT MANAGER",
        "authorized_official_telephone_number": "763-349-6740"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MedExpress Urgent Care - DeLand, N Woodland Blvd",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Deland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.