Provider Demographics
NPI:1003226549
Name:FAMILY MED CHOICE, INC
Entity Type:Organization
Organization Name:FAMILY MED CHOICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FELIPE
Authorized Official - Middle Name:
Authorized Official - Last Name:BASSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-620-7155
Mailing Address - Street 1:18356 NW 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-2934
Mailing Address - Country:US
Mailing Address - Phone:305-620-7155
Mailing Address - Fax:
Practice Address - Street 1:18356 NW 47TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-2934
Practice Address - Country:US
Practice Address - Phone:305-620-7155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13651526784261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTIN
FL=========OtherEIN