Provider Demographics
NPI:1114012598
Name:WE CARE FAMILY MEDICAL GROUP
Entity Type:Organization
Organization Name:WE CARE FAMILY MEDICAL GROUP
Other - Org Name:OSCEOLA MEDICAL WALK IN CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:SR
Authorized Official - Credentials:CFO
Authorized Official - Phone:407-673-5528
Mailing Address - Street 1:907 B NORTH CENTRAL
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759
Mailing Address - Country:US
Mailing Address - Phone:407-846-1687
Mailing Address - Fax:407-870-0251
Practice Address - Street 1:907 B NORTH CENTRAL
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759
Practice Address - Country:US
Practice Address - Phone:407-846-1687
Practice Address - Fax:407-870-0251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME 93515OtherDR JOHNNY THOMAS
FLME 25252OtherDR JUAN C RICHARDS
FLME 86928OtherDR FLORIDALIA CRUZ
FLD59930Medicare UPIN
FLH45013Medicare UPIN
FLD15576Medicare UPIN