Provider Demographics
NPI:1225019219
Name:FAMILY CARE ASSOCIATES
Entity Type:Organization
Organization Name:FAMILY CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-237-9201
Mailing Address - Street 1:720 EAST CEDAR ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2060
Mailing Address - Country:US
Mailing Address - Phone:574-237-9201
Mailing Address - Fax:574-239-1489
Practice Address - Street 1:720 E CEDAR ST
Practice Address - Street 2:SUITE 320
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2060
Practice Address - Country:US
Practice Address - Phone:574-237-9201
Practice Address - Fax:574-239-1489
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH BEND CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-08
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN146470Medicare PIN