Provider Demographics
NPI:1437141686
Name:SALAZAR FAMILY HEALTH CARE, INC
Entity Type:Organization
Organization Name:SALAZAR FAMILY HEALTH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-604-2235
Mailing Address - Street 1:PO BOX 1312
Mailing Address - Street 2:
Mailing Address - City:MULBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:33860-1312
Mailing Address - Country:US
Mailing Address - Phone:863-604-2235
Mailing Address - Fax:863-646-8575
Practice Address - Street 1:708 N CHURCH AVE
Practice Address - Street 2:
Practice Address - City:MULBERRY
Practice Address - State:FL
Practice Address - Zip Code:33860-2034
Practice Address - Country:US
Practice Address - Phone:863-425-9309
Practice Address - Fax:863-425-8401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2524166OtherAETNA
FLCH9637OtherRR MEDICARE
FL45760OtherBLUE SHIELD FL
FL=========OtherTRICARE
FL=========OtherTRICARE
FL45760OtherBLUE SHIELD FL