Provider Demographics
NPI:1053449884
Name:FAMILY MEDICAL CARE INC
Entity Type:Organization
Organization Name:FAMILY MEDICAL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANTE
Authorized Official - Middle Name:R
Authorized Official - Last Name:ORETA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-473-1002
Mailing Address - Street 1:501 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENUP
Mailing Address - State:KY
Mailing Address - Zip Code:41144-1033
Mailing Address - Country:US
Mailing Address - Phone:606-473-1002
Mailing Address - Fax:
Practice Address - Street 1:501 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENUP
Practice Address - State:KY
Practice Address - Zip Code:41144-1033
Practice Address - Country:US
Practice Address - Phone:606-473-1002
Practice Address - Fax:606-473-0075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27710261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
50C9OtherBLUES CROSS
OH0147899Medicaid
4603114OtherAENTA
KY65924326Medicaid
OH0147899Medicaid
50C9OtherBLUES CROSS