Provider Demographics
NPI:1245379965
Name:FAMILY FIRST MEDICAL CARE LLC
Entity Type:Organization
Organization Name:FAMILY FIRST MEDICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISHNA IYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-443-4242
Mailing Address - Street 1:1012 DRUID RD E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-5606
Mailing Address - Country:US
Mailing Address - Phone:727-443-4242
Mailing Address - Fax:727-441-1158
Practice Address - Street 1:1012 DRUID RD E
Practice Address - Street 2:SUITE 100
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-5606
Practice Address - Country:US
Practice Address - Phone:727-443-4242
Practice Address - Fax:727-441-1158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44742207LP2900X
FLME26372207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAC110OtherMEDICARE GROUP PROVIDER NUMBER