Provider Demographics
NPI:1336123785
Name:FAMILY CARE ASSOCIATES LLC
Entity Type:Organization
Organization Name:FAMILY CARE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MROZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-462-1208
Mailing Address - Street 1:7570 W 21ST ST N
Mailing Address - Street 2:STE 1006B
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1734
Mailing Address - Country:US
Mailing Address - Phone:316-462-1208
Mailing Address - Fax:316-462-1214
Practice Address - Street 1:7570 W 21ST ST N
Practice Address - Street 2:STE 1006B
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1734
Practice Address - Country:US
Practice Address - Phone:316-462-1208
Practice Address - Fax:316-462-1214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110651Medicare ID - Type Unspecified