Provider Demographics
NPI:1598163990
Name:FAMILY CARE AFFILIATES OF OCALA LLC
Entity Type:Organization
Organization Name:FAMILY CARE AFFILIATES OF OCALA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ORAEDU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-690-6000
Mailing Address - Street 1:1830 SE 18TH AVE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-8348
Mailing Address - Country:US
Mailing Address - Phone:352-690-6000
Mailing Address - Fax:352-690-6643
Practice Address - Street 1:1830 SE 18TH AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-8348
Practice Address - Country:US
Practice Address - Phone:352-690-6000
Practice Address - Fax:352-690-6643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-17
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN-203208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001015100Medicaid
FL001015100Medicaid