Provider Demographics
NPI:1619257961
Name:FAMILY INTERNAL MEDICINE OF OCALA
Entity Type:Organization
Organization Name:FAMILY INTERNAL MEDICINE OF OCALA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:KUCHAKULLA
Authorized Official - Middle Name:N
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-732-9844
Mailing Address - Street 1:1623 SW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6528
Mailing Address - Country:US
Mailing Address - Phone:352-732-9844
Mailing Address - Fax:352-351-4305
Practice Address - Street 1:1623 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6528
Practice Address - Country:US
Practice Address - Phone:352-732-9844
Practice Address - Fax:352-351-4305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-18
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Single Specialty