Provider Demographics
NPI:1427198365
Name:FAMILY MEDICINE ASSOCIATES
Entity Type:Organization
Organization Name:FAMILY MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SALVATO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-719-3525
Mailing Address - Street 1:210 N ALEXANDER ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-4362
Mailing Address - Country:US
Mailing Address - Phone:813-719-3525
Mailing Address - Fax:813-719-3175
Practice Address - Street 1:210 N ALEXANDER ST
Practice Address - Street 2:SUITE B
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563
Practice Address - Country:US
Practice Address - Phone:813-719-3525
Practice Address - Fax:813-719-3175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4095Medicare PIN