Provider Demographics
NPI:1376712158
Name:CENTRE FOR FAMILY MEDICINE
Entity Type:Organization
Organization Name:CENTRE FOR FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-729-8088
Mailing Address - Street 1:241 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903
Mailing Address - Country:US
Mailing Address - Phone:321-729-8088
Mailing Address - Fax:321-729-8487
Practice Address - Street 1:241 6TH AVE
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903
Practice Address - Country:US
Practice Address - Phone:321-729-8088
Practice Address - Fax:321-729-8487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE38224Medicare UPIN
FL80187TMedicare PIN