Provider Demographics
NPI:1508107244
Name:FAMILY CARE 1 LLC
Entity Type:Organization
Organization Name:FAMILY CARE 1 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-691-0012
Mailing Address - Street 1:330 SW 19TH LN
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-3714
Mailing Address - Country:US
Mailing Address - Phone:239-691-0012
Mailing Address - Fax:
Practice Address - Street 1:1411 SE 16TH PL
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990
Practice Address - Country:US
Practice Address - Phone:236-673-6516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-05
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108892207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty