Provider Demographics
NPI:1679913859
Name:FAMILY MEDICAL CLINIC, LLC
Entity Type:Organization
Organization Name:FAMILY MEDICAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCOBAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-342-5620
Mailing Address - Street 1:8180 NW 36TH ST
Mailing Address - Street 2:STE 102
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6645
Mailing Address - Country:US
Mailing Address - Phone:786-342-5620
Mailing Address - Fax:
Practice Address - Street 1:8180 NW 36TH ST
Practice Address - Street 2:STE 102
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6645
Practice Address - Country:US
Practice Address - Phone:786-342-5620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center