Provider Demographics
NPI:1316046170
Name:FAMILY PRACTICE ASSOCIATES, PA
Entity Type:Organization
Organization Name:FAMILY PRACTICE ASSOCIATES, PA
Other - Org Name:FAMILY PRACTICE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:HOLSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-726-5533
Mailing Address - Street 1:101 S OSCEOLA AVE
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4727
Mailing Address - Country:US
Mailing Address - Phone:352-726-5533
Mailing Address - Fax:352-726-5818
Practice Address - Street 1:101 S OSCEOLA AVE
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4727
Practice Address - Country:US
Practice Address - Phone:352-726-5533
Practice Address - Fax:352-726-5818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS004629207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD27377Medicare UPIN
FLK6250Medicare PIN