Provider Demographics
NPI:1508996208
Name:GAINESVILLE FAMILY HEALTHCARE PA
Entity Type:Organization
Organization Name:GAINESVILLE FAMILY HEALTHCARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAMTA
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-359-2258
Mailing Address - Street 1:9508 SW 33RD LN
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-8652
Mailing Address - Country:US
Mailing Address - Phone:352-333-8370
Mailing Address - Fax:352-331-5260
Practice Address - Street 1:100 SW 75TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-5779
Practice Address - Country:US
Practice Address - Phone:352-331-5277
Practice Address - Fax:352-331-5260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87889207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAH603Medicare PIN