Provider Demographics
NPI:1598703167
Name:FAMILY CARE MEDICAL CENTER II INC
Entity Type:Organization
Organization Name:FAMILY CARE MEDICAL CENTER II INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORA
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:ROBLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-512-1767
Mailing Address - Street 1:18518 NW 67TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3304
Mailing Address - Country:US
Mailing Address - Phone:305-512-1767
Mailing Address - Fax:305-512-1766
Practice Address - Street 1:18518 NW 67TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3304
Practice Address - Country:US
Practice Address - Phone:305-512-1767
Practice Address - Fax:305-512-1766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7777Medicare PIN