Provider Demographics
NPI:1114514809
Name:FAMILY CARE MEDICAL CENTER II LLC
Entity Type:Organization
Organization Name:FAMILY CARE MEDICAL CENTER II LLC
Other - Org Name:FAMILY CARE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CETIN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:863-491-2277
Mailing Address - Street 1:819 N MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:FL
Mailing Address - Zip Code:34266-8716
Mailing Address - Country:US
Mailing Address - Phone:863-491-2277
Mailing Address - Fax:863-491-3077
Practice Address - Street 1:819 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-8716
Practice Address - Country:US
Practice Address - Phone:863-491-2277
Practice Address - Fax:863-491-3077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-29
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty