Provider Demographics
NPI:1215180096
Name:FAMILY MEDICINE CONSULTANTS CORP.
Entity Type:Organization
Organization Name:FAMILY MEDICINE CONSULTANTS CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:GIVENS
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:219-882-7730
Mailing Address - Street 1:650 GRANT ST STE 5
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46404-1551
Mailing Address - Country:US
Mailing Address - Phone:219-882-7730
Mailing Address - Fax:219-882-1605
Practice Address - Street 1:650 GRANT ST STE 5
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-1551
Practice Address - Country:US
Practice Address - Phone:219-882-7730
Practice Address - Fax:219-882-1605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002672A281P00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No281P00000XHospitalsChronic Disease Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200171090BMedicaid
IN200171090BMedicaid
ING98568Medicare UPIN