Provider Demographics
NPI:1578016820
Name:FAMILY CARE PHYSICIAN GROUP
Entity Type:Organization
Organization Name:FAMILY CARE PHYSICIAN GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-968-1755
Mailing Address - Street 1:45669 HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-4546
Mailing Address - Country:US
Mailing Address - Phone:863-866-2551
Mailing Address - Fax:863-866-2552
Practice Address - Street 1:45669 HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33897-4546
Practice Address - Country:US
Practice Address - Phone:863-866-2551
Practice Address - Fax:863-866-2552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-03
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty