Provider Demographics
NPI:1609231299
Name:FLORIDA FAMILY PRIMARY CARE CENTER OF PASCO LLC
Entity Type:Organization
Organization Name:FLORIDA FAMILY PRIMARY CARE CENTER OF PASCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OCTAVIO
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTCH BRAVO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-905-1399
Mailing Address - Street 1:PO BOX 13188
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33681-3188
Mailing Address - Country:US
Mailing Address - Phone:727-873-3891
Mailing Address - Fax:
Practice Address - Street 1:7463 STATE ROAD 52
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-6714
Practice Address - Country:US
Practice Address - Phone:727-873-3891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care