NPIMap

Dwic of Tampa Bay, Inc

Organization Active NPI Urgent Care Clinic/Center · Lakeland, FL

NPI 1902376973 · NPPES record last updated May 7, 2024

Key facts

NPI
1902376973
Entity type
Organization (NPI type 2)
Primary specialty
Urgent Care Clinic/Center 261QU0200X
Legal business name
DWIC OF TAMPA BAY, INC
Practice address
3700 US Highway 98 N Unit 101
Lakeland, FL 33809-3863
Phone
(863) 815-9523
Fax
(863) 815-9524
NPI assigned
Dec 3, 2018
Organization subpart
No

Authorized official

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

Other NPIs on the same Medicare enrollment 22

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

Corporate family (same tax ID) 6

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 4

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

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    NPD
  • Jennifer Sierra, ARNP Psychiatric/Mental Health Nurse Practitioner · Wellington, FL · NPI 1003365461
    NPD
  • Lindsey Brooke Hull, FNP-BC Family Nurse Practitioner · Woonsocket, RI · NPI 1922344407
    NPD

Medicare participation

Medicare fee-for-service enrollment
Enrolled in FL

Medicare enrollment records

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…

National Provider Directory

Tax ID family
Dwic of Tampa Bay Inc (7 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP		 207P00000X
Urgent Care Clinic/Center 261QU0200X Yes

Addresses

Primary practice location

3700 US Highway 98 N Unit 101
Lakeland, FL 33809-3863

Mailing address

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

Other names

  • MedExpress Urgent Care - Lakeland, N Road 98 Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 7, 2024.

{
    "created_epoch": "1543795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715040000000",
    "number": "1902376973",
    "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": "3700 US HIGHWAY 98 N UNIT 101",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338093863",
            "telephone_number": "863-815-9523",
            "fax_number": "863-815-9524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DWIC OF TAMPA BAY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-03",
        "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": "207P00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "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 - Lakeland, N Road 98",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MedExpress Urgent Care - Lakeland, N Road 98",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakeland, FL

All providers in Lakeland, FL · Urgent Care Clinic/Center in Florida

Sources for this page

Verify at the official NPI Registry.