Provider Demographics
NPI:1437700044
Name:R & J FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:R & J FAMILY MEDICINE LLC
Other - Org Name:SUNSHINE FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROXENE
Authorized Official - Middle Name:
Authorized Official - Last Name:RILES
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:904-429-4188
Mailing Address - Street 1:3955 58TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-6003
Mailing Address - Country:US
Mailing Address - Phone:727-347-2557
Mailing Address - Fax:
Practice Address - Street 1:3955 58TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-6003
Practice Address - Country:US
Practice Address - Phone:727-347-2557
Practice Address - Fax:904-429-4188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-25
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGOtherFL HF MEDICARE
FLPENDINGMedicaid