Provider Demographics
NPI:1417591710
Name:FAMILY HEALTH MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:FAMILY HEALTH MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:V
Authorized Official - Last Name:PUJOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-802-2217
Mailing Address - Street 1:2801 W WATERS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-1866
Mailing Address - Country:US
Mailing Address - Phone:813-304-1001
Mailing Address - Fax:813-304-1024
Practice Address - Street 1:2801 W WATERS AVE STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-1866
Practice Address - Country:US
Practice Address - Phone:813-304-1001
Practice Address - Fax:813-304-1024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation