Quicmed Walk in Centers LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

ME74735 Issued in FL

Legal business name

QUICMED WALK IN CENTERS LLC

Practice address

11223 N Williams St
Dunnellon, FL 34432-8350

Phone

(352) 522-1101

NPI assigned

Sep 10, 2007

Last updated

Dec 20, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. John T Chacko, MD

Title

Managing Director

Phone

(352) 522-1101

Specialties & licenses 3

Addresses

Locations

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

{
    "created_epoch": "1189382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229731200000",
    "number": "1295920676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11223 N WILLIAMS ST",
            "city": "DUNNELLON",
            "state": "FL",
            "postal_code": "344328350",
            "telephone_number": "352-522-1101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11223 N WILLIAMS ST",
            "city": "DUNNELLON",
            "state": "FL",
            "postal_code": "344328350",
            "telephone_number": "352-522-1101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUICMED WALK IN CENTERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-10",
        "last_updated": "2008-12-20",
        "status": "A",
        "authorized_official_last_name": "CHACKO",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "352-522-1101",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME74735",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME74735",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "FL",
            "license": "ME74735",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.