Provider Demographics
NPI:1184831430
Name:ENGLEWOOD FAMILY HEALTH CARE CENTER INC
Entity Type:Organization
Organization Name:ENGLEWOOD FAMILY HEALTH CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHACE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-474-9314
Mailing Address - Street 1:2400 S MCCALL RD STE C
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34224-5136
Mailing Address - Country:US
Mailing Address - Phone:941-473-2913
Mailing Address - Fax:941-473-9813
Practice Address - Street 1:2400 S MCCALL RD STE C
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34224-5136
Practice Address - Country:US
Practice Address - Phone:941-473-2913
Practice Address - Fax:941-473-9813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39585Medicare ID - Type UnspecifiedMEDICARE GROUP #